Thalamic Neuromodulation: New Frontiers
Recommended Citation
Hsu J, Ali R, Air E, Englot D, Muh CR, Richardson RM, and Rammo R. Thalamic Neuromodulation: New Frontiers. Epilepsy Curr 2026.
Document Type
Article
Publication Date
1-22-2026
Publication Title
Epilepsy currents / American Epilepsy Society
Keywords
deep brain stimulation; drug-resistant epilepsy; neuromodulation; responsive neurostimulation; stereoelectroencephalography; thalamus
Abstract
Thalamic neuromodulation for drug-resistant epilepsy has evolved from ablative thalamotomy to network-guided deep-brain stimulation (DBS) and responsive neurostimulation (RNS). Currently, the only Food and Drug Administration-approved DBS target is the anterior thalamic nucleus, which provides substantial and durable seizure reduction, particularly in limbic and temporal epilepsies. There is growing evidence that the centromedian and pulvinar nuclei are implicated in generalized, multifocal, and posterior neocortical epilepsies. Advanced imaging, probabilistic atlases, and connectomics can be used to refine targeting; however, they are limited by patient specificity, acquisition burden, and interatlas variability. Thalamic stereoelectroencephalography may clarify potential neuromodulation target selection by characterizing ictal recruitment, network dynamics, and biomarkers. Although DBS and RNS each have unique benefits, no modality has demonstrated superior. Pediatric data are heterogeneous and scarcer, but seizure reduction and safety profiles are similar to adults. Further studies are needed to optimize neuromodulation target selection and programming paradigms.
PubMed ID
41584905
ePublication
ePub ahead of print
First Page
15357597261416388
Last Page
15357597261416388
