Treating refractory generalized epilepsy with stimulation.

Commentary Idiopathic generalized epilepsies (IGE) represent around 20% of all new-onset epilepsy and are controlled with various an-tiepileptic drugs in up to 80% of the cases. For the remaining 20% with intractable IGE, treatment options are limited. Most new AED clinical trials evaluate cohorts with partial epilepsy. The ketogenic diet has helped many children with catastrophic symptomatic generalized epilepsy, but its applicability as a viable, long-term, treatment option in adults is questionable (1). Some uncontrolled series suggest a benefit of vagus nerve stimulation in reducing the frequency of convulsions in generalized epilepsy (GE), but the extent and " longevity " of this success remains to be proven in controlled randomized prospective evaluations (2). Resective epilepsy surgery is simply not an option for patients with GE or rapidly synchronizing bihemispheric epileptic networks. In this " lay of the land, " any attempt to bring an intractable GE treatment closer to the therapeutic armamentarium is hugely welcome, and the work highlighted in this commentary is very timely. In this study, Valentin et al. report a single-blind, controlled trial evaluating the efficacy of bilateral centromedian thalamic nucleus (CMN) stimulation for seizure control in generalized epilepsy and frontal lobe epilepsy. Electrode placement was stereotactically guided and confirmed by intraoperative EEG recordings. A postoperative 1-week period of scalp video-EEG with externalized electrodes allowed for optimization of the stimulation settings, and patients were then followed for at least 6 months. Stimulation was continuous, at a frequency at 60 HZ with pulse width of 90 μs, and up to 5V. Although the number of patients studied is small (11 total, including six with GE), the results are very encouraging, with >50% improvement in seizure frequency seen in all patients with GE, including two patients who were completely seizure free for 12 and 50 months, respectively. Considering that study patients had at least 10 seizures/month prior to implantation, the benefit is PURPOSE: Deep brain stimulation (DBS) of the thalamus is an emerging surgical option for people with medically refractory epilepsy that is not suitable for resective surgery, or in whom surgery has failed. Our main aim was to evaluate the efficacy of bilateral centromedian thalamic nucleus (CMN) DBS for seizure control in generalized epilepsy and frontal lobe epilepsy with a two-center, single-blind, controlled trial. METHODS: Participants were adults with refrac-tory generalized or frontal lobe epilepsy. Seizure diaries were kept by patients/carers prospectively from enrollment. The baseline preimplantation period …