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The following is a summary of “Ictal Involvement of the Pulvinar and the Anterior Nucleus of the Thalamus in Patients With Refractory Epilepsy,” published in the November 2024 issue of Neurology by McGinn et al.   

Deep brain stimulation (DBS) targeting the anterior nucleus of the thalamus (ANT) has been effective in treating some patients with medically refractory epilepsy. However, the role of thalamic nuclei in seizure propagation remains unclear.  

Researchers conducted a retrospective study to investigate the roles of the ANT and pulvinar (PLV) in seizure propagation in patients with refractory epilepsy.  

They analyzed electroencephalogram (EEG) data and clinical notes from patients with refractory epilepsy who underwent stereo-electroencephalography (sEEG) electrode implantation across cortical regions, including the ANT and PLV. Seizure onset zones, typically temporal, and the thalamic sites were also focused.  

The results showed that the thalamus was involved during seizures in 100% of the 17 patients (mean age 32 years). Of these, 88% were involved in both the ANT and PLV, and 82% had initial involvement in PLV. In patients with confirmed hippocampal or amygdalar onset seizures, 62% had initial PLV involvement, and 100% had subsequent involvement of PLV, while only 31% showed initial propagation to ANT. All focal-to-bilateral tonic-clonic seizures and most focal impaired awareness seizures showed early involvement of both ANT and PLV, with rapid spread to the contralateral nuclei.  

They concluded that the PLV nucleus played a prominent role in seizure propagation, which may inform future treatment strategies like DBS.  

Source: neurology.org/doi/10.1212/WNL.0000000000210039