Improving the effectiveness of ANT DBS therapy for epilepsy with optimal current targeting

OBJECTIVE: Deep brain stimulation of the ANT is a novel treatment option in refractory epilepsy with an established efficacy at the group level. However, data on the effect of individualized programming are currently lacking. We report the effect of programming changes on outcome in deep brain stimulation of anterior nucleus of thalamus (ANT DBS). Secondly, we investigated whether the effect differs between seizure types. Thirdly, we compared the response status between patients with stimulation contacts verified inside the ANT with patients with contacts located outside of ANT. METHODS: The participants were 27 consecutive patients with ANT DBS implantation with at least two‐year follow‐up. Seizures were subdivided into focal aware (FAS), focal impaired awareness (FIAS), and focal to bilateral tonic‐clonic seizures (FBTCS). The patients’ seizure diaries were analyzed retrospectively to assess changes in different seizure types. Active contact locations for each patient were verified from preoperative MRI and postoperative CT fusion images using SureTune III (Medtronic Inc, Minneapolis, MN) software. RESULTS: A significant reduction in monthly mean seizure frequency occurred in FIAS: 56% at two‐year and 65% at five‐year follow‐up. The effects on FAS and FBTCS were less pronounced. Patients with contacts inside the ANT or on the anterolateral border of ANT experienced a greater reduction in seizure frequency than patients with outside‐ANT contacts. Ultimately, seven patients became responders due to changes in DBS programming or repositioning of contacts, increasing our responder rate from 44% to 70% as measured by a seizure reduction of at least 50%. SIGNIFICANCE: ANT DBS appears to be especially effective in reducing FIAS, when the appropriately chosen contacts are activated.