Deep Brain Stimulation of the Centromedian Nucleus of the Thalamus for Lennox-Gastaut Syndrome: A Systematic Review and Individual Patient Data Analysis

• Published in: Neurosurgery Vol. 92; no. 4; pp. 703 - 715
• Main Authors: Shlobin, Nathan A, Hofmann, Katherine, Cohen, Nathan T, Koubeissi, Mohamad Z, Gaillard, William D, Oluigbo, Chima O
• Format: Journal Article
• Language: English
• Published: United States 01-04-2023
• Subjects: Child; Deep Brain Stimulation; Epilepsy - therapy; Humans; Intralaminar Thalamic Nuclei; Lennox Gastaut Syndrome - therapy; Quality of Life
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/neu.0000000000002280

Lennox-Gastaut syndrome (LGS) is a severe childhood-onset pharmacoresistant epilepsy. Deep brain stimulation (DBS) of the centromedian nucleus of the thalamus (CMN) has been utilized.
To conduct a systematic review and individual patient data (IPD) analysis to characterize outcomes of DBS of CMN in LGS.
PubMed, Embase, and Scopus were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles were screened by title/abstract then full text. Included articles were reviewed for bibliographic, demographic, and outcome data. IPD were extracted from studies providing IPD for all patients.
Of 72 resultant articles, 10 studies (114 patients) were included. Six of 7 studies reporting the outcome of ≥50% seizure reduction indicated that ≥50% of patients achieved this, with improved functional ability. Seizure freedom rate was generally <10%. Six studies with 47 patients provided IPD. The mean ages at epilepsy onset and CMN DBS were 3.9 ± 4.5 years and 17.4 ± 8.8 years, respectively. Nineteen of 41 (46.3%) patients had positive MRI findings. Seizure types included atypical absence in 39 (83.0%) patients, generalized tonic-clonic in 32 (68.1%), tonic in 22 (46.8%), and atonic in 20 (42.6%). Thirty-eight (80.9%) patients experienced ≥50% reduction in seizure frequency, and only 3 (6.4%) experienced seizure freedom. The mean seizure reduction was 62.9% ± 31.2% overall. Quality of life improved in 30/34 (88.2%) and was unchanged in the remainder (11.8%). The complication rate was 2/41 (4.9%). The mean length of follow-up was 19.8 ± 26.1 months (IQR: 4-18 months).
Limited data indicate that DBS of the CMN may be effective and safe for people with LGS.