Acute Disruption of Cortical Epileptiform Discharges With Thalamic Stimulation.

Summary: Thalamic neuromodulation has emerged as a promising treatment for drug-resistant epilepsy, with deep brain stimulation of the anterior nucleus of the thalamus currently Food and Drug Administration approved for this purpose. The Stimulation of the Anterior Nucleus of Thalamus for Epilepsy trial demonstrated that chronic anterior nucleus of the thalamus stimulation can significantly reduce seizure burden. In addition, the centromedian nucleus is gaining interest as a potential neuromodulation target among epilepsy experts, though its use remains off-label. Effective selection of neuromodulation targets requires reliable biomarkers, ideally with real-time feedback, yet studies on the acute effects of thalamic stimulation on epileptiform activity remain limited. Our cases provide novel evidence of acute suppression of epileptiform activity in the cerebral cortex-specifically, the cingulate and insular cortices-after anterior nucleus of the thalamus and centromedian nucleus stimulation, respectively, through stereoelectroencephalography electrodes. This finding enhances our understanding of cortical responses to thalamic stimulation and supports its therapeutic potential in both chronic and acute settings. Emerging research suggests that other thalamic nuclei may also play a role in managing epilepsy originating from different brain regions. We emphasize that routine stereoelectroencephalography implantation in thalamic nuclei may provide valuable clinical insights and aid in selecting the optimal target for stimulation. This case mini-series contributes to the growing evidence supporting the therapeutic potential of thalamic neuromodulation in epilepsy treatment.