Deep brain stimulation (DBS) in the treatment of bilateral temporal lobe drug-resistant epilepsy: an analysis of 8 cases

Abstract

Background. Although resection of the epileptogenic zone remains the primary treatment for patients with drug-resistant epilepsy (DRE), it cannot be performed in 30–57 % of cases due to the localization of the epileptogenic zone in functional brain areas or in cases of bilateral brain involvement. In such situations, the neuromodulation methods are used, including deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS), the efficacy of which was demonstrated in the SANTE studies. Aim. To evaluate the efficacy of ANT-DBS implantation in patients with bilateral temporal DRE. Materials and methods. A retrospective single-center study was conducted on patients treated for focal DRE at the Pirogov National Medical and Surgical Center from 2020 to 2024. The study included 8 patients with bilateral temporal DRE who underwent ANT-DBS implantation. Surgical efficacy was assessed using the McHugh scale. The follow-up period was 12 months. Results. During the follow-up there were no cases of serious adverse events associated with the implantation procedure or chronic stimulation. Analysis of the dynamics of seizure frequency 12 months after ANT-DBS system implantation demonstrated the following results: 2 (25 %) patients achieved more than 80 % reduction in seizure frequency (McHugh class I), 3 (37.5 %) patients showed more than 50 % reduction in seizure frequency (McHugh class II), 2 (25 %) patients had a 30–50 % reduction in seizure frequency (McHugh class III), 1 (12.5 %) patient did not show significant reduction in seizure frequency (McHugh class IV). Conclusion. Implantation of electrodes in the anterior nuclei of the thalamus with subsequent chronic stimulation can be an alternative neuromodulation technique for treating patients with DRE when resection surgery is not indicated, including the cases of bilateral temporal epilepsy.