Exploiting Thalamocortical Interactions for Seizure Termination in Multifocal Epilepsy
Abstract
Post-traumatic epilepsy is one of the most common causes of acquired epilepsy, with military personnel comprising the highest incidence of post-traumatic epilepsy, impacting their health and well-being. Antiseizure medication is the first resort for such patients, but epilepsy resulting from brain trauma is one of the hardest to treat. Some patients are now treated with deep brain stimulation (DBS) or responsive neurostimulation (RNS), which use electrical pulses to disrupt seizures. A common target for stimulation is the thalamus, which makes connections to widespread brain areas. While thalamic stimulation works for some patients, others see no benefit at all. Working out who would benefit from the device would not only help clinicians to devise better therapeutic options, but also save patients from unnecessary brain surgery and the many trips to the clinic needed to configure the device, only to discover that it is ineffective. The core goal of the proposed study is to understand who may benefit from thalamic stimulation and how the thalamus adapts to stimulation over time. The general hypothesis of this work is that thalamic activity may influence only a subset of seizures. We propose that it is possible to identify these seizures and use this information to find out who may benefit from thalamic stimulation (Aim 1). The most significant obstacle in our way is ignorance; we currently have no idea how the thalamus affects seizure activity. To address this, we will analyze the signals recorded from the thalamus and other brain regions to identify how the thalamus interacts with the rest of the brain during seizures (Aim 2). Finally, we will analyze brain activity from patients with RNS implants to work out whether thalamic stimulation induces short- or long-term changes that make epileptic patients less susceptible to seizures (Aim 3). The ability to identify which patients with post-traumatic epilepsy might respond to thalamic stimulation, informed by the work of this proposal, will be the first of its kind to empower patients to make more informed choices, allowing them to better manage their expectations, and avoid unnecessary surgical risks and potentially years of fruitless clinical hours. We anticipate that our findings will not only inspire the development of novel patient-specific modes of treatment, but also empower clinicians with the ability to provide meaningful guidance to patients with post-traumatic epilepsy in particular, who suffer from one the most untreatable variations of epilepsy.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210315
Entities
People
- Pariya Salami
Organizations
- Massachusetts General Hospital
- United States Army