European Expert Opinion on ANT-DBS therapy for patients with drug-resistant epilepsy (a Delphi consensus). (October 2020)

• Record Type: Journal Article
• Authors: Kaufmann, Elisabeth; Bartolomei, Fabrice; Boon, Paul; Chabardes, Stéphan; Colon, Albert J.; Eross, Loránd; Fabó, Dániel; Gonçalves-Ferreira, Antonio; Imbach, Lukas L.; Van Paesschen, Wim; Peltola, Jukka; Rego, Ricardo; Theys, Tom; Voges, Berthold
• Is Part Of: Seizure. Volume 81(2020)
• Page Start: 201
• Page End: 209
• Publication Date: 2020-10
• Subjects: ANT-DBS -- Deep brain stimulation -- Epilepsy -- Delphi consensus; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2020.08.015
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: This is the first expert opinion report on ANT-DBS therapy for epilepsy. European experts reviewed the literature and shared their experience on ANT-DBS. Recommendations are given for patient selection, management and outcome evaluation. Abstract: Introduction: Although deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) represents an established third-line therapy for patients with drug-resistant focal epilepsy, guiding reports on practical treatment principles remain scarce. Methods: An Expert Panel (EP) of 10 European neurologists and 4 neurosurgeons was assembled to share their experience with ANT-DBS therapy. The process included a review of the current literature, which served as a basis for an online survey completed by the EP prior to and following a face-to-face meeting (Delphi method). An agreement level of ≥71 % was considered as consensus. Results: Out of 86 reviewed studies, 46 (53 %) were selected to extract information on the most reported criteria for patient selection, management, and outcome. The Delphi process yielded EP consensus on 4 parameters for selection of good candidates and patient management as well as 7 reasons of concern for this therapy. Since it was not possible to give strict device programming advice due to low levels of evidence, the experts shared their clinical practice: all of them start with monopolar stimulation, 79 % using the cycling mode. Most (93 %) EP members set the initial stimulation frequency and pulse width according to the SANTE parameters, while there is more variability in the amplitudes used. Further agreement was achieved on a list of 7 patient outcome parameters to be monitored during the follow-up. Conclusions: Although current evidence is too low for definite practical guidelines, this EP report could support the selection and management of patients with ANT-DBS.