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Review article
DOI: 10.1016/j.neucie.2021.04.001
Available online 29 April 2021
Neuromodulation of the anterior thalamic nucleus as a therapeutic option for difficult-to-control epilepsy
Neuromodulación del núcleo talámico anterior como opción terapéutica para epilepsia de difícil control
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Juan Carlos Moreira-Holguína,b,
Corresponding author
, David Andrés Barahona-Moránb, José Hidalgo-Esmeraldasb, Cristian Guzmán-Rochinab
a Servicio de Neurocirugía, Hospital de Especialidades Guayaquil “Dr. Abel Gilbert Pontón”, Guayaquil, Ecuador
b Escuela de Medicina, Universidad de Guayaquil, Guayaquil, Ecuador
Received 15 April 2020. Accepted 16 December 2020
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Abstract

Deep brain stimulation (DBS) consists of the electrical stimulation of the subcortical structures by implanting electrodes connected to a pulse generator. The thalamus, being a structure that has multiple connections with various parts of the central nervous system, is a suitable target for DBS. The anterior thalamic nucleus (ANT) serves as an important relay site for the limbic system by receiving input from the hippocampus and mammillary bodies, and sending input to the cingulate gyrus; thus forming the Papez circuit. Due to these connections, the ANT constitutes an ideal route for the propagation of epileptogenic activity. ANT-DBS has excellent results in the control of complex partial seizures. The vast majority of patients with ANT-DBS have shown a significant reduction in the frequency of their seizures of more than 50%.

Keywords:
Anterior thalamic nucleus
Refractory epilepsy
Deep brain stimulation
Seizures
Resumen

La estimulación cerebral profunda (ECP) consiste en la estimulación eléctrica de las estructuras subcorticales mediante el implante de electrodos conectados a un generador de impulsos. El tálamo, al ser una estructura que posee múltiples conexiones con diversas partes del sistema nervioso central, es un target adecuado para la ECP. El núcleo talámico anterior (NA) sirve como un sitio de relevo importante para el sistema límbico al recibir aferencias desde el hipocampo y los cuerpos mamilares, y enviar eferencias hacia el giro del cíngulo; formando así el circuito de Papez. Debido a estas conexiones, el NA constituye una vía idónea para la propagación de la actividad epileptogénica. La ECP-NA tiene excelentes resultados en el control de las crisis parciales complejas. La gran mayoría de pacientes con ECP-NA han demostrado una reducción significativa en la frecuencia de sus crisis de más del 50%.

Palabras clave:
Núcleo talámico anterior
Epilepsia refractaria
Estimulación cerebral profunda
Convulsiones

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