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Review
. 2024 Oct;26(5):626-637.
doi: 10.1002/epd2.20255. Epub 2024 Jul 30.

CM-Pf deep brain stimulation in polyneuromodulation for epilepsy

W O Tatum  1 , B Freund  1 , E H Middlebrooks  2 , B N Lundstrom  3 , A M Feyissa  1 , J J Van Gompel  4 , S S Grewal  5
Affiliations
Review

CM-Pf deep brain stimulation in polyneuromodulation for epilepsy

W O Tatum et al. Epileptic Disord. 2024 Oct.

Abstract

Objective: Neuromodulation is a viable option for patients with drug-resistant epilepsies. We reviewed the management of patients with two deep brain neurostimulators. In addition, patients implanted with a device targeting the centromedian-parafascicular (CM-Pf) nuclear complex supplements this report to provide an illustrative case to implantation and programming a patient with three active devices.

Methods: A narrative review using PubMed and Embase identified patients with drug-resistant epilepsy implanted with more than one neurostimulator was performed. Combinations of vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS) were identified. We provide a background of a newly reported case of an adult with a triple implant eventually responding to CM-Pf DBS as the third implant following suboptimal benefit from VNS and RNS.

Results: In review of the literature, dual-device therapy is increasing in reports of use with combinations of VNS, RNS, and DBS to treat patients with drug-resistant epilepsy. We review dual-device implants with thalamic DBS device combinations, functional neural networks, and programming patients with dual devices. CM-Pf is a new target for DBS and has shown a variable response in focal epilepsy. We report the unique case of 28-year-old male with drug-resistant focal epilepsy who experienced a 75% seizure reduction with CM-Pf DBS as his third device after suboptimal responses to VNS and RNS. After 9 months, he also experienced seizure freedom from recurrent focal to bilateral tonic-clonic seizures. No medical or surgical complications or safety issues were encountered.

Conclusion: We demonstrate safety and feasibility in an adult combining active VNS, RNS, and CM-Pf DBS. Patients with dual-device therapy who experience a suboptimal response to initial device use at optimized settings should not be considered a neuromodulation "failure." Strategies to combine devices require a working knowledge of brain networks.

Keywords: centromedian‐parafascicularis; deep brain stimulation; devices; drug resistance; epilepsy; neuromodulation; neurostimulators; seizures; surgery; thalamus.

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References

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