From the Research
For intractable seizures, targeting the centromedian thalamic nucleus (CM) is recommended, as it has been shown to be effective in reducing seizure frequency, particularly for patients with generalized seizures or multifocal epilepsy. The CM represents a key target for deep brain stimulation (DBS) therapy, with studies demonstrating its involvement in the genesis, propagation, and arrest of epileptic activity 1. Recent studies have further supported the use of CM DBS, with one study showing an average seizure reduction of 82.6% in patients with drug-resistant epilepsy 2. The CM's role in modulating neural networks contributing to seizure propagation and consciousness makes it a promising target for neurostimulation therapy 3. While other thalamic nuclei, such as the anterior nucleus of the thalamus (ANT), may also be considered, the CM is a primary target for DBS therapy, particularly for patients with generalized seizures or Lennox-Gastaut syndrome.
Some key points to consider when targeting the CM for DBS therapy include:
- The CM's involvement in the onset of generalized tonic-clonic convulsions and typical absences, as well as its role in the propagation of secondary generalized tonic-clonic convulsions 1
- The use of electrical stimulation at specific frequencies, such as 3 Hz and 6 Hz, to induce spike-and-wave complexes and recruiting-like responses 1
- The importance of accurate electrode placement and stimulation parameters to achieve optimal therapeutic effects 2
- The potential for CM DBS to be effective in reducing seizure frequency and improving quality of life for patients with drug-resistant epilepsy, particularly those with generalized seizures or multifocal epilepsy 2, 3
Overall, the evidence suggests that targeting the CM is a promising approach for the treatment of intractable seizures, particularly for patients with generalized seizures or multifocal epilepsy. The use of CM DBS therapy should be considered for patients who have failed at least two appropriate antiepileptic medications and are not candidates for resective surgery or have failed such interventions.