Responsive neurostimulation (RNS) is a well-established therapy for drug-resistant focal epilepsy. While thalamic targets are increasingly explored in complex cases, revision surgeries remain rare and technically challenging due to imaging artifacts from implanted hardware. Here, we present a case of thalamic lead revision and review the existing literature on RNS revisions to contextualize its feasibility and outcomes. This report highlights both the clinical rationale/outcome of CM lead augmentation and a practical image-fusion strategy for trajectory planning in the setting of implant-related imaging artifact.
We report a case of RNS revision in a 30-year-old woman with multifocal drug-resistant epilepsy who underwent re-implantation targeting the centromedian (CM) thalamic nucleus using a novel image fusion approach. To assess existing evidence, a focused literature review was conducted using PubMed with predefined inclusion criteria: studies reporting RNS lead revision in patients with epilepsy. Relevant data on demographics, indication for revision, targets, and outcomes were extracted.
The patient underwent safe implantation of a thalamic lead following a preoperative co-registration of historical contrast-enhanced MRI with perioperative imaging. At 6 months, the patient showed a significant reduction in seizure frequency. In our review, 12 articles were screened, of which 4 met inclusion criteria. All reported lead revision for inadequate seizure control or lead malfunction. Three of the four patients had favorable outcomes, including one seizure-free and two with ≥50% seizure reduction. No complications were reported. No study described thalamic lead placement or the use of image fusion for trajectory planning.
RNS lead revision may be a viable strategy in patients with suboptimal seizure control. Our case is the first to describe revision involving thalamic targeting with advanced imaging techniques. Although data remain limited, growing clinical experience suggests that revising RNS systems, including to thalamic targets, can enhance seizure outcomes in selected patients. Further prospective data are needed to guide patient selection and targeting strategies.
- Thalamic Stimulation for Drug-Resistant Focal Epilepsy: A Case Report and Focused Literature Review of RNS Lead Revision
- Bashar Dawoud - University of MiamiRyan O'Boyle - Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, USADanny John - University of MiamiAlejandro N. Santos - University of MiamiSai Sanikommu - University of MiamiGuilherme Piedade Santos - University of UtahJoacir Graciolli Cordeiro - University of MiamiJonathan Jagid - University of Miami
- Seizure (London, England), Vol.137, p.53
- Elsevier Ltd; LONDON
- 9
- UMMG Dept of Neurological Surgery; Miller School of Medicine
- English
- Journal article
- 41795252
- 991033020208602976