Cortical and thalamic electrode implant followed by temporary continuous subthreshold stimulation yields long-term seizure freedom: A case report

• Main Authors: Juan Luis Alcala-Zermeno, Nicholas M. Gregg, Jamie J. Van Gompel, Matt Stead, Gregory A. Worrell, Brian Nils Lundstrom
• Format: Article
• Language: English
• Published: Elsevier 2020-01-01
• Series: Epilepsy & Behavior Reports
• Subjects: Drug-resistant epilepsy; Seizure freedom; Chronic subthreshold cortical stimulation; Chronic subthreshold stimulation; Neuromodulation; Anterior thalamic nucleus
• Online Access: http://www.sciencedirect.com/science/article/pii/S2589986420300381

Neuromodulation strategies that target the epileptogenic network are options for treating focal drug-resistant epilepsy. These brain stimulation approaches include responsive neurostimulation and more recently, chronic subthreshold stimulation. Long-term seizure freedom with neuromodulation is uncommon. Seizure control typically requires ongoing froms of electrical stimulation. Here, we present the case of a patient implanted with three cortical electrodes targeting the inferior frontal lobe, insula, and one subcortical electrode targeting the ipsilateral anterior thalamic nucleus. This patient received continuous subthreshold electrical stimulation to the frontal electrodes for 7 months, at which time stimulation was inadvertently stopped. He has now been free of seizures for 42 months. This case suggests the possibility that neuromodulation can alter epileptogenic networks and lead to seizure freedom without ongoing electrical stimulation.