Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of intractable seizures

R. S. Fisher, S. Uematsu, Gregory Krauss, B. J. Cysyk, R. McPherson, Ronald P Lesser, Barry Gordon, P. Schwerdt, M. Rise

Research output: Contribution to journalArticle

Abstract

Stimulation of centromedian (CM) thalamic nuclei has been proposed as a treatment for seizures. We implanted programmable subcutaneous (s.c.) stimulators into CM bilaterally in 7 patients with intractable epilepsy to test feasibility and safety. Stimulation was on or off in 3-month blocks, with a 3-month washout period in a double-blind, cross-over protocol. Stimuli were delivered as 90-μs pulses at 65 pulses/s, 1 min of each 5 min for 2 h/day, with voltage set to half the sensory threshold. Stimulation was safe and well-tolerated, with a mean reduction of tonic-clonic seizure frequency of 30% with respect to baseline when stimulator was on versus a decrease of 8% when the stimulator was off. There was no improvement in total number of generalized seizures with stimulation, and treatment differences were not statistically significant. Stimulation at low intensity did not alter the EEG acutely, but high-intensity stimulation induced slow waves or 2-3 Hz spike- waves with ipsilateral frontal maximum. In an open-label follow-up segment with stimulator trains continuing for 24 h/day, 3 of 6 patients reported at least a 50% decrease in seizure frequency. There were no side effects. This pilot project demonstrated the feasibility of controlled study of thalamic stimulation in epilepsy, but further study will be needed to demonstrate efficacy.

Original languageEnglish (US)
Pages (from-to)841-851
Number of pages11
JournalEpilepsia
Volume33
Issue number5
DOIs
StatePublished - 1992
Externally publishedYes

Fingerprint

Seizures
Placebos
Sensory Thresholds
Intralaminar Thalamic Nuclei
Feasibility Studies
Therapeutics
Electroencephalography
Epilepsy
Safety

Keywords

  • Brain stimulation
  • Centromedian nucleus
  • Clinical trials
  • Epilepsy
  • Human
  • Thalamus

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of intractable seizures. / Fisher, R. S.; Uematsu, S.; Krauss, Gregory; Cysyk, B. J.; McPherson, R.; Lesser, Ronald P; Gordon, Barry; Schwerdt, P.; Rise, M.

In: Epilepsia, Vol. 33, No. 5, 1992, p. 841-851.

Research output: Contribution to journalArticle

Fisher, R. S. ; Uematsu, S. ; Krauss, Gregory ; Cysyk, B. J. ; McPherson, R. ; Lesser, Ronald P ; Gordon, Barry ; Schwerdt, P. ; Rise, M. / Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of intractable seizures. In: Epilepsia. 1992 ; Vol. 33, No. 5. pp. 841-851.
@article{8ce4448fd5a14a19aceab91d1a9d8233,
title = "Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of intractable seizures",
abstract = "Stimulation of centromedian (CM) thalamic nuclei has been proposed as a treatment for seizures. We implanted programmable subcutaneous (s.c.) stimulators into CM bilaterally in 7 patients with intractable epilepsy to test feasibility and safety. Stimulation was on or off in 3-month blocks, with a 3-month washout period in a double-blind, cross-over protocol. Stimuli were delivered as 90-μs pulses at 65 pulses/s, 1 min of each 5 min for 2 h/day, with voltage set to half the sensory threshold. Stimulation was safe and well-tolerated, with a mean reduction of tonic-clonic seizure frequency of 30{\%} with respect to baseline when stimulator was on versus a decrease of 8{\%} when the stimulator was off. There was no improvement in total number of generalized seizures with stimulation, and treatment differences were not statistically significant. Stimulation at low intensity did not alter the EEG acutely, but high-intensity stimulation induced slow waves or 2-3 Hz spike- waves with ipsilateral frontal maximum. In an open-label follow-up segment with stimulator trains continuing for 24 h/day, 3 of 6 patients reported at least a 50{\%} decrease in seizure frequency. There were no side effects. This pilot project demonstrated the feasibility of controlled study of thalamic stimulation in epilepsy, but further study will be needed to demonstrate efficacy.",
keywords = "Brain stimulation, Centromedian nucleus, Clinical trials, Epilepsy, Human, Thalamus",
author = "Fisher, {R. S.} and S. Uematsu and Gregory Krauss and Cysyk, {B. J.} and R. McPherson and Lesser, {Ronald P} and Barry Gordon and P. Schwerdt and M. Rise",
year = "1992",
doi = "10.1111/j.1528-1157.1992.tb02192.x",
language = "English (US)",
volume = "33",
pages = "841--851",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of intractable seizures

AU - Fisher, R. S.

AU - Uematsu, S.

AU - Krauss, Gregory

AU - Cysyk, B. J.

AU - McPherson, R.

AU - Lesser, Ronald P

AU - Gordon, Barry

AU - Schwerdt, P.

AU - Rise, M.

PY - 1992

Y1 - 1992

N2 - Stimulation of centromedian (CM) thalamic nuclei has been proposed as a treatment for seizures. We implanted programmable subcutaneous (s.c.) stimulators into CM bilaterally in 7 patients with intractable epilepsy to test feasibility and safety. Stimulation was on or off in 3-month blocks, with a 3-month washout period in a double-blind, cross-over protocol. Stimuli were delivered as 90-μs pulses at 65 pulses/s, 1 min of each 5 min for 2 h/day, with voltage set to half the sensory threshold. Stimulation was safe and well-tolerated, with a mean reduction of tonic-clonic seizure frequency of 30% with respect to baseline when stimulator was on versus a decrease of 8% when the stimulator was off. There was no improvement in total number of generalized seizures with stimulation, and treatment differences were not statistically significant. Stimulation at low intensity did not alter the EEG acutely, but high-intensity stimulation induced slow waves or 2-3 Hz spike- waves with ipsilateral frontal maximum. In an open-label follow-up segment with stimulator trains continuing for 24 h/day, 3 of 6 patients reported at least a 50% decrease in seizure frequency. There were no side effects. This pilot project demonstrated the feasibility of controlled study of thalamic stimulation in epilepsy, but further study will be needed to demonstrate efficacy.

AB - Stimulation of centromedian (CM) thalamic nuclei has been proposed as a treatment for seizures. We implanted programmable subcutaneous (s.c.) stimulators into CM bilaterally in 7 patients with intractable epilepsy to test feasibility and safety. Stimulation was on or off in 3-month blocks, with a 3-month washout period in a double-blind, cross-over protocol. Stimuli were delivered as 90-μs pulses at 65 pulses/s, 1 min of each 5 min for 2 h/day, with voltage set to half the sensory threshold. Stimulation was safe and well-tolerated, with a mean reduction of tonic-clonic seizure frequency of 30% with respect to baseline when stimulator was on versus a decrease of 8% when the stimulator was off. There was no improvement in total number of generalized seizures with stimulation, and treatment differences were not statistically significant. Stimulation at low intensity did not alter the EEG acutely, but high-intensity stimulation induced slow waves or 2-3 Hz spike- waves with ipsilateral frontal maximum. In an open-label follow-up segment with stimulator trains continuing for 24 h/day, 3 of 6 patients reported at least a 50% decrease in seizure frequency. There were no side effects. This pilot project demonstrated the feasibility of controlled study of thalamic stimulation in epilepsy, but further study will be needed to demonstrate efficacy.

KW - Brain stimulation

KW - Centromedian nucleus

KW - Clinical trials

KW - Epilepsy

KW - Human

KW - Thalamus

UR - http://www.scopus.com/inward/record.url?scp=0026799304&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026799304&partnerID=8YFLogxK

U2 - 10.1111/j.1528-1157.1992.tb02192.x

DO - 10.1111/j.1528-1157.1992.tb02192.x

M3 - Article

C2 - 1396427

AN - SCOPUS:0026799304

VL - 33

SP - 841

EP - 851

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

IS - 5

ER -