BACKGROUND AND OBJECTIVES Deep brain stimulation (DBS) targeting the anterior nucleus of the thalamus (ANT) has been shown to be effective in treating some patients with medically refractory epilepsy. However, it remains unknown how seizures spread through the ANT relative to other thalamic nuclei. This study aimed to investigate, through simultaneous recordings from both ANT and pulvinar (PLV) nucleus, their roles in seizure propagation. Our goal was to determine whether the ANT is the primary site of seizure propagation in the human thalamus, especially for focal seizure originating in the medial temporal lobe. METHODS In a retrospective design, we studied EEGs and clinical notes of patients with refractory epilepsy who were implanted with stereo-EEG (sEEG) electrodes across cortical regions, some of which were extended to reach various sites of the thalamus (i.e., multisite thalamic recordings). We selected patients from the Stanford Comprehensive Epilepsy Center with both ANT and PLV electrodes and collected information about the timing and anatomy of seizure activity in the seizure onset zones, usually temporal, and the 2 thalamic sites. RESULTS We recruited 17 (5 female, mean age 32 years) adult patients with simultaneous ipsilateral ANT and PLV recordings. In all patients, the procedure was safe without any complications. In 100% of patients, the thalamus was involved during seizures (in 88% both ANT and PLV and in 82% first the PLV). In patients with confirmed hippocampal or amygdalar onset seizures, 62% had initial involvement and 100% had subsequent involvement of the PLV nucleus. Only 31% showed initial propagation to ANT. All focal-to-bilateral tonic-clonic seizures and most of the focal impaired awareness seizures had early involvement of both ANT and PLV, with rapid spread to the contralateral nuclei. DISCUSSION sEEG of thalamic nuclei simultaneously provides an opportunity to understand propagation patterns of seizures with respect to each thalamic subdivision at the individual level. The patterns of seizure propagation, as we report here, provide insights about the prominent involvement of the PLV nucleus during seizure propagation. This may motivate future prospective work in larger cohorts of patients to understand how thalamic propagation may predict response to resective/ablative surgery or whether personalization of DBS (for instance, PLV instead of, or together with, ANT) could improve clinical outcomes.

中文翻译：

---

难治性癫痫患者丘脑上髓和丘脑前核的发作期受累。


背景和目标 针对丘脑前核 （ANT） 的深部脑刺激 （DBS） 已被证明可有效治疗一些医学难治性癫痫患者。然而，相对于其他丘脑核，癫痫发作是如何通过 ANT 传播的仍然未知。本研究旨在通过 ANT 和 pulvinar （PLV） 核的同时记录来研究它们在癫痫发作传播中的作用。我们的目标是确定 ANT 是否是人类丘脑癫痫发作传播的主要部位，尤其是起源于内侧颞叶的局灶性癫痫发作。方法 在回顾性设计中，我们研究了难治性癫痫患者的脑电图和临床记录，这些患者在皮质区域植入立体脑电图 （sEEG） 电极，其中一些电极被扩展到丘脑的各个部位（即，多部位丘脑记录）。我们从斯坦福综合癫痫中心选择了同时使用 ANT 和 PLV 电极的患者，并收集了有关癫痫发作区（通常是颞部）和 2 个丘脑部位癫痫发作活动的时间和解剖结构的信息。结果我们招募了 17 例 （5 例女性，平均年龄 32 岁） 同时记录同侧 ANT 和 PLV 的成年患者。在所有患者中，手术都是安全的，没有任何并发症。在 100% 的患者中，丘脑在癫痫发作期间受累 （88% 的 ANT 和 PLV，82% 的患者首先是 PLV）。在确诊海马或杏仁核癫痫发作的患者中，62% 的患者最初受累，100% 的患者随后受累 PLV 核。只有 31% 显示出初始传播到 ANT。 所有局灶性至双侧强直阵挛发作和大多数局灶性意识障碍癫痫发作都早期累及 ANT 和 PLV，并迅速扩散到对侧核。讨论 丘脑核的 sEEG 同时提供了一个机会，可以在个体水平上了解癫痫发作相对于每个丘脑细分的传播模式。正如我们在这里报道的那样，癫痫发作传播的模式提供了有关 PLV 核在癫痫发作传播过程中的突出参与的见解。这可能会激励未来在更大患者队列中的前瞻性工作，以了解丘脑传播如何预测对切除/消融手术的反应，或者 DBS 的个性化（例如，PLV 代替 ANT 或与 ANT 一起）是否可以改善临床结果。