Antiepileptic effect of high-frequency stimulation of the subthalamic nucleus (corpus luysi) in a case of medically intractable epilepsy caused by focal dysplasia: A 30-month follow-up: Technical case report

Alim Louis Benabid, Lorella Minotti, Adnan Koudsié, Anne De Saint Martin, Edouard Hirsch, Patrick J. Kelly, Nicholas M. Barbaro, Philip Starr, Imad Najm, Ali R. Rezai, Andres M. Lozano

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

OBJECTIVE AND IMPORTANCE: Currently, some forms of epilepsy are resistant to both pharmacological and surgical interventions. As a result, there is a need for new therapeutic strategies. Because the nigral system modulates neuronal excitability in animal models of epilepsy, we considered therapeutic high-frequency stimulation of the subthalamic nucleus (STN). We were encouraged by the known relationship between the STN and the nigral system, as well as by our experience with high-frequency stimulation of the STN in Parkinsonian patients. CLINICAL PRESENTATION: A 5-year-old girl with pharmacologically resistant, inoperable epilepsy caused by focal centroparietal dysplasia underwent implantation with a permanent electrode in the left STN and was chronically stimulated. To date, we have followed up this patient for 30 months postoperatively. TECHNIQUE: High-frequency stimulation of the STN induced a significant voltage-dependent reduction (by 80%) in the number and severity of seizures. In addition, consistent improvement in both motor and cognitive functions was noted as a result of reduced postictal states. The effect was more prominent for seizures occurring in clusters (89% reduction) and during the day (88% reduction) than for those that occurred during sleep (53% reduction). CONCLUSION: This is the first report of epilepsy control using chronic high-frequency stimulation of the STN. Preliminary observations in three other operated patients (at 2, 12, and 18 mo) confirm these data. We think that high-frequency stimulation of the STN may hold significant future potential as a treatment for epilepsy, similar to its established role in the treatment of Parkinson's disease. This finding opens completely new experimental and therapeutic avenues for the treatment of surgically and medically intractable epilepsy.

Original languageEnglish (US)
Pages (from-to)1385-1392
Number of pages8
JournalNeurosurgery
Volume50
Issue number6
DOIs
StatePublished - Jun 1 2002

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Subthalamic Nucleus
Anticonvulsants
Epilepsy
Substantia Nigra
Seizures
Therapeutics
Partial Epilepsy
Drug Resistant Epilepsy
Cognition
Parkinson Disease
Sleep
Electrodes
Animal Models
Pharmacology

Keywords

  • Deep brain stimulation
  • Dysplasia
  • Epilepsy
  • Stereotaxy
  • Subthalamic nucleus

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Antiepileptic effect of high-frequency stimulation of the subthalamic nucleus (corpus luysi) in a case of medically intractable epilepsy caused by focal dysplasia : A 30-month follow-up: Technical case report. / Benabid, Alim Louis; Minotti, Lorella; Koudsié, Adnan; De Saint Martin, Anne; Hirsch, Edouard; Kelly, Patrick J.; Barbaro, Nicholas M.; Starr, Philip; Najm, Imad; Rezai, Ali R.; Lozano, Andres M.

In: Neurosurgery, Vol. 50, No. 6, 01.06.2002, p. 1385-1392.

Research output: Contribution to journalArticle

Benabid, AL, Minotti, L, Koudsié, A, De Saint Martin, A, Hirsch, E, Kelly, PJ, Barbaro, NM, Starr, P, Najm, I, Rezai, AR & Lozano, AM 2002, 'Antiepileptic effect of high-frequency stimulation of the subthalamic nucleus (corpus luysi) in a case of medically intractable epilepsy caused by focal dysplasia: A 30-month follow-up: Technical case report', Neurosurgery, vol. 50, no. 6, pp. 1385-1392. https://doi.org/10.1097/00006123-200206000-00037
Benabid, Alim Louis ; Minotti, Lorella ; Koudsié, Adnan ; De Saint Martin, Anne ; Hirsch, Edouard ; Kelly, Patrick J. ; Barbaro, Nicholas M. ; Starr, Philip ; Najm, Imad ; Rezai, Ali R. ; Lozano, Andres M. / Antiepileptic effect of high-frequency stimulation of the subthalamic nucleus (corpus luysi) in a case of medically intractable epilepsy caused by focal dysplasia : A 30-month follow-up: Technical case report. In: Neurosurgery. 2002 ; Vol. 50, No. 6. pp. 1385-1392.
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abstract = "OBJECTIVE AND IMPORTANCE: Currently, some forms of epilepsy are resistant to both pharmacological and surgical interventions. As a result, there is a need for new therapeutic strategies. Because the nigral system modulates neuronal excitability in animal models of epilepsy, we considered therapeutic high-frequency stimulation of the subthalamic nucleus (STN). We were encouraged by the known relationship between the STN and the nigral system, as well as by our experience with high-frequency stimulation of the STN in Parkinsonian patients. CLINICAL PRESENTATION: A 5-year-old girl with pharmacologically resistant, inoperable epilepsy caused by focal centroparietal dysplasia underwent implantation with a permanent electrode in the left STN and was chronically stimulated. To date, we have followed up this patient for 30 months postoperatively. TECHNIQUE: High-frequency stimulation of the STN induced a significant voltage-dependent reduction (by 80{\%}) in the number and severity of seizures. In addition, consistent improvement in both motor and cognitive functions was noted as a result of reduced postictal states. The effect was more prominent for seizures occurring in clusters (89{\%} reduction) and during the day (88{\%} reduction) than for those that occurred during sleep (53{\%} reduction). CONCLUSION: This is the first report of epilepsy control using chronic high-frequency stimulation of the STN. Preliminary observations in three other operated patients (at 2, 12, and 18 mo) confirm these data. We think that high-frequency stimulation of the STN may hold significant future potential as a treatment for epilepsy, similar to its established role in the treatment of Parkinson's disease. This finding opens completely new experimental and therapeutic avenues for the treatment of surgically and medically intractable epilepsy.",
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AU - Minotti, Lorella

AU - Koudsié, Adnan

AU - De Saint Martin, Anne

AU - Hirsch, Edouard

AU - Kelly, Patrick J.

AU - Barbaro, Nicholas M.

AU - Starr, Philip

AU - Najm, Imad

AU - Rezai, Ali R.

AU - Lozano, Andres M.

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