Faculty Bibliography

PURPOSE: Animal studies and sporadic case reports in human subjects have suggested that intermittent electrical stimulation of the anterior nucleus of the thalamus reduces seizure activity. We embarked on an open-label pilot study to determine initial safety and tolerability of bilateral stimulation of the anterior nucleus of the thalamus (ANT), to determine a range of appropriate stimulation parameters, and to begin to gather pilot efficacy data. METHODS: We report an open-label pilot study of intermittent electrical stimulation of the anterior nucleus of the thalamus in five patients (three men, two women; age range, 24-47 years), with follow-up between 6 and 36 months. All patients had intractable partial epilepsy. Four of the five patients also had secondarily generalized seizures. Stimulation was delivered by bilateral implantable, programmable devices by using an intermittent, relatively high-frequency protocol. Stimulation parameters were 100 cycles per second with charge-balanced alternating current; pulse width, 90 ms; and voltages ranging between 1.0 and 10.0 V. Seizure counts were monitored and compared with preimplantation baseline. RESULTS: Four of the five patients showed clinically and statistically significant improvement with respect to the severity of their seizures, specifically with respect to the frequency of secondarily generalized tonic-clonic seizures and complex partial seizures associated with falls. One patient showed a statistically significant reduction in total seizure frequency. No adverse events could clearly be attributed to stimulation. None of the patients could determine whether the stimulator was on or off at these parameters. CONCLUSIONS: Electrical stimulation of the ANT appears to be well tolerated. Preliminary evidence suggests clinical improvement in seizure control in this small group of intractable patients. Further controlled study of deep brain stimulation of the anterior nucleus is warranted

We review the literature concerning the initial presentation of neurosyphilis in status epilepticus (SE) and provide an additional case of a 41-year-old male with no past medical history of seizures who presented in status epilepticus with subsequent laboratory confirmation of neurosyphilis. Neurosyphilis should be considered in the differential diagnosis of patients presenting with status epilepticus

The current evidence-based data on efficacy, safety, and administration of the 7 new antiepileptic drugs (AEDs) approved over the past 10 years by the US Food and Drug Administration to treat new-onset and refractory epilepsy in children and adults is summarized based on the recent American Academy of Neurology (AAN) guidelines. The clinical trial work still necessary as well as areas where such research would not be informative and those in which nonevidence-based strategies are needed are highlighted in efforts to provide clinicians with the most up-to-date information on treatment regimens for patients with epilepsy. The limited amount of data currently available on these newer AEDs and the existence of traditionally efficacious medications complicate therapeutic decision-making for the clinician. Neurologists are encouraged to integrate the AAN guidelines with clinical experience, opinion, and other considerations of special populations until an exhaustive set of guidelines is available for a wide variety of seizure types