Robert Fisher

Neurostimulation for epilepsy, including a pilot study of anterior nucleus stimulation

Graves NM, Fisher RS. Clinical Neurosurgery. 2005: 52 1-8

Electrical stimulation of the anterior nucleus of thalamus seems to be well tolerated; however, past experience with deep brain stimulation (DBS) implantation suggests some risk for serious adverse events, including hemorrhage and infection. In a review of DBS therapy for movement disorders, Loddenkemper et al.25 compared the estimated risk of significant morbidity and mortality for electrode placement using stereotactic minimal invasive surgery (less than 2%) with the estimated risk of mortality in patients with uncontrolled seizures (0.5% per year). Preliminary evaluation of our epilepsy pilot study suggests clinical improvement in seizure control in this small group of patients, extending over a 12-month period. Because there was no control group, it is not known what proportion of the observed reduction in seizure frequency was caused by a placebo effect or a microlesion effect from the electrode implantation. A randomized, double-blinded, placebo controlled, parallel design study of AN stimulation is currently ongoing in the United States, and should serve to clarify the safety and efficacy of DBS for epilepsy.