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Kaufmann, Elisabeth; Bartolomei, Fabrice; Boon, Paul; Chabardes, Stephan; Colon, Albert J.; Eross, Lorand; Fab, Daniel; Goncalves-Ferreira, Antonio; Imbach, Lukas L.; Paesschen, Wim van; Peltola, Jukka; Rego, Ricardo; Theys, Tom; Voges, Berthold (2020): European Expert Opinion on ANT-DBS therapy for patients with drug-resistant epilepsy (a Delphi consensus). In: Seizure-European Journal of Epilepsy, Vol. 81: pp. 201-209
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Abstract

Introduction: Although deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) represents an established third-line therapy for patients with drug-resistant focal epilepsy, guiding reports on practical treatment principles remain scarce. Methods: An Expert Panel (EP) of 10 European neurologists and 4 neurosurgeons was assembled to share their experience with ANT-DBS therapy. The process included a review of the current literature, which served as a basis for an online survey completed by the EP prior to and following a face-to-face meeting (Delphi method). An agreement level of >= 71 % was considered as consensus. Results: Out of 86 reviewed studies, 46 (53 %) were selected to extract information on the most reported criteria for patient selection, management, and outcome. The Delphi process yielded EP consensus on 4 parameters for selection of good candidates and patient management as well as 7 reasons of concern for this therapy. Since it was not possible to give strict device programming advice due to low levels of evidence, the experts shared their clinical practice: all of them start with monopolar stimulation, 79 % using the cycling mode. Most (93 %) EP members set the initial stimulation frequency and pulse width according to the SANTE parameters, while there is more variability in the amplitudes used. Further agreement was achieved on a list of 7 patient outcome parameters to be monitored during the follow-up. Conclusions: Although current evidence is too low for definite practical guidelines, this EP report could support the selection and management of patients with ANT-DBS.