Placebo-Controlled Pilot Study of Centromedian Thalamic Stimulation in Treatment of Intractable Seizures

Authors

  • Robert S. Fisher,

    Corresponding author
    1. Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A.
    2. Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A.
      Address correspondence and reprint requests to Dr. R. S. Fisher at Neurophysiology and Epilepsy Center, Barrow Neurological Institute, 8B37, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013-4496, U.S.A.
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  • Sumio Uematsu,

    1. Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A.
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  • Gregory L. Krauss,

    1. Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A.
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  • Barbara J. Cysyk,

    1. Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A.
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  • Robert McPherson,

    1. Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, U.S.A.
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  • Ronald P. Lesser,

    1. Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A.
    2. Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A.
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  • Barry Gordon,

    1. Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A.
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  • Pamela Schwerdt,

    1. Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, U.S.A.
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  • Mark Rise

    1. Department of Medtronic Neuro Division, Minneapolis, Minnesota, U.S.A.
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  • This work is presented in part at the American Epilepsy Society meeting, San Diego, California, November 1990, and published in abstract form in Epilepsia 1990;31:604.

Address correspondence and reprint requests to Dr. R. S. Fisher at Neurophysiology and Epilepsy Center, Barrow Neurological Institute, 8B37, St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd., Phoenix, AZ 85013-4496, U.S.A.

Abstract

Summary: Stimulation of centromedian (CM) thalamic nuclei has been proposed as a treatment for seizures. We implanted programmable subcutaneous (s.c.) stimulators into CM bilaterally in 7 patients with intractable epilepsy to test feasibility and safety. Stimulation was on or off in 3-month blocks, with a 3-month washout period in a double-blind, cross-over protocol. Stimuli were delivered as 9O-μs pulses at 65 pulses/s, 1 min of each 5 min for 2 h/day, with voltage set to half the sensory threshold. Stimulation was safe and well-tolerated, with a mean reduction of tonic-clonic seizure frequency of 30% with respect to baseline when stimulator was on versus a decrease of 8% when the stimulator was off. There was no improvement in total number of generalized seizures with stimulation, and treatment differences were not statistically significant. Stimulation at low intensity did not alter the EEG acutely, but high-intensity stimulation induced slow waves or 2–3 Hz spike-waves with ipsilateral frontal maximum. In an open-label follow-up segment with stimulator trains continuing for 24 h/day, 3 of 6 patients reported at least a 50% decrease in seizure frequency. There were no side effects. This pilot project demonstrated the feasibility of controlled study of thalamic stimulation in epilepsy, but further study will be needed to demonstrate efficacy.

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