Wieser
Fakultäten » Medizinische Fakultät » Neurologie, Klinik für » Prof. Dr. Heinz-Gregor Wieser (emeritiert) » Wieser
Completed research project
| Title / Titel | Subthalamic and thalamic stereotactic recordings and stimulations in patients with intractable epilepsy. | ||||
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| Abstract (PDF, 14 KB) | |||||
| Summary / Zusammenfassung | With the renewed interest in deep brain stimulation and their targets we revisited the Stereo-EEG archives and documented several patients with depth recordings from and stimulation of subthalamic and thalamic sites, as well as from periaqueductal gray. The subthalamic sites, in particular the Forel-H fields, were studied in five patients with the goal to learn more about this area with a view towards Jinnai`s Forel-H-tomy. Purpose and General Aims of this Book Brain stimulation for seizure control has succeeded the era of lesioning deep relay nuclei. The National Institute of Neurological Disorder and Stroke (NINDS) is presently supporting investigations using electrical recording and electrical stimulation and/or local drug delivery in the central nervous system at demand. Cerebellar stimulation, Vagal nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), DBS either targeting the subthalamic nucleus (STN), the anterior thalamic nucleus, or the hippocampal formation have been used in the management of epilepsy patients who are medically intractable and not amenable to classical resective epilepsy surgery. The National Institute of Neurological Disorder and Stroke (NINDS) is presently supporting investigations using electrical recording and electrical stimulation and/or local drug delivery in the central nervous system at demand. However, with respect to the role of DBS in epilepsy, data are still very limited. The available reviews clearly show that much has to be done in order to answer the questions as to the efficacy of DBS. Patient selection criteria (focal vs. generalized), stimulation modality (constant vs. cycling, open loop vs. closed loop), stimulation parameters, stimulation target nuclei vs. fiber tracts have to be studied before the effectiveness of this treatment modality can be assessed. At present DBS is an experimental procedure that warrants further studies. On the background of this ongoing discussion on the role of thalamic and subthalamic nuclei in epilepsies on one hand, DBS of thalamic and subthalamic nuclei on the other, we presented ten patients who underwent Stereo-EEG (SEEG) explorations with a view towards epilepsy surgery at the Zurich University Hospital. These patients had electrodes in Forel H (patients 1 to 5) or in thalamic nuclei (patients 6 to 11). In addition, we illustrate one patient with Creutzfeldt Jakob Disease with thalamic and cortical recordings (patient 12). Furthermore, we summarize our limited experience with recordings and stimulations in the periaqueductal gray matter (PGM - Cases 12 to 16), with DC recording and DC polarisation, as well with biochemical measurements of excitatory and inhibitory transmitters and transmitter candidates released in the primary epileptogenic area during spontaneous and electrically induced epileptic discharges. All patients are illustrated with their most relevant findings in order to answer the following basic questions. (1) Do cortical seizure discharges spread to the above mentioned deep brain structures, and with which characteristics? (2) Do interictal epileptic graphoelements originate in or spread to these deep brain structures? (3) What is the effect of cortical and/or subcortical electrical stimulation? (a) with regard to deep brain nuclei, (b) with regard to interictal and ictal epileptiform EEG potentials, and (c) with regard to biochemical measurements. (4) Which components of SEP and cognitive potentials can be recorded in these deep brain structures? (5) Finally, in those patients with therapeutic stereotactic lesions, what is the clinical efficacy of lesions in thalamic sites? |
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| Publications / Publikationen | Wieser HG, Zumsteg D.Subthalamic and thalamic stereotactic recordings and stimulations in patients with intractable epilepsy. John Libbey Eurotext, Paris, 2007 (in press) | ||||
| Project leadership and contacts / Projektleitung und Kontakte |
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| Funding source(s) / Unterstützt durch |
Foundation, Private Sector (e.g. Industry) |
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| Duration of Project / Projektdauer | May 2005 to Oct 2007 |