Targeting the centromedian nucleus of the thalamus for epilepsy

Approximately one-third of the 50 million patients with epilepsy worldwide are resistant to pharmacological treatments and may require aggressive interventions, such as surgery. However, many patients do not benefit from surgery due to anatomical challenges or multifocal epileptogenic origins. Deep brain stimulation (DBS) is a promising alternative for these patients. DBS modulates neurotransmitter activity to prevent seizure propagation and has already been approved for the treatment of Parkinson’s disease and essential tremors. Although the anterior nucleus of the thalamus is the only DBS target approved for drug resistant epilepsy in Europe and Canada, the centromedian nucleus (CM) has emerged as a promising target, particularly for generalized and frontal lobe seizures. The CM is challenging to target because of its small size and complex connections, and it cannot be easily visualized using conventional imaging. This study focused on advanced methods for CM identification, including specialized magnetic resonance imaging sequences, intraoperative neurophysiological recordings, and diffusion tensor imaging tractography. These techniques are crucial for precise DBS targeting and for improving seizure control in affected patients. Our findings indicate that combining these advanced imaging and neurophysiological methods enhances the accuracy of DBS, potentially expanding its therapeutic applications in epilepsy. By optimizing CM-DBS electrode placement, these approaches can improve clinical outcomes in drug resistant epilepsy, making them vital for effective treatment strategies.