Acute Brain Activation Patterns of High- Versus Low-Frequency Stimulation of the Anterior Nucleus of the Thalamus During Deep Brain Stimulation for Epilepsy

Erik H. Middlebrooks, Ayushi Jain, Lela Okromelidze, Chen Lin, Erin M. Westerhold, Chad A. O'Steen, Anthony L. Ritaccio, Alfredo Quiñones-Hinojosa, William O. Tatum, Sanjeet S. Grewal

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is an increasingly utilized treatment of drug-resistant epilepsy. To date, the effect of high-frequency stimulation (HFS) vs low-frequency stimulation (LFS) in ANT DBS is poorly understood. OBJECTIVE: To assess differences in the acute effect of LFS vs HFS in ANT DBS utilizing blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI). METHODS: In this prospective study of 5 patients with ANT DBS for epilepsy, BOLD activation and deactivation were modeled for 145-Hz and 30-Hz ANT stimulation using an fMRI block design. Data were analyzed with a general linear model and combined via 2-stage mixed-effects analysis. Z-score difference maps were nonparametrically thresholded using cluster threshold of z > 3.1 and a (corrected) cluster significance threshold of P = .05. RESULTS: HFS produced significantly greater activation within multiple regions, in particular the limbic and default mode network (DMN). LFS produced minimal activation and failed to produce significant activation within these same networks. HFS produced widespread cortical and subcortical deactivation sparing most of the limbic and DMN regions. Meanwhile, LFS produced deactivation in most DMN and limbic structures. CONCLUSION: Our results show that HFS and LFS produce substantial variability in both local and downstream network effects. In particular, largely opposing effects were identified within the limbic network and DMN. These findings may serve as a mechanistic basis for understanding the potential of HFS vs LFS in various epilepsy syndromes.

Original languageEnglish (US)
Pages (from-to)901-908
Number of pages8
JournalNeurosurgery
Volume89
Issue number5
DOIs
StatePublished - Oct 13 2021

Keywords

  • Anterior nucleus
  • Deep brain stimulation
  • Epilepsy
  • Thalamus

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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