A team from the University of Pittsburgh and UPMC has introduced a personalized brain stimulation approach for treating hard-to-treat epilepsy, reducing seizures by nearly 90% in some patients.
Innovations in epilepsy treatment are on the horizon thanks to a new study by doctors and researchers from the University of Pittsburgh and UPMC. Published in Nature Communications, the breakthrough approach leverages personalized deep brain stimulation (DBS) to target specific regions in the brain, offering life-changing results for patients who don’t respond to conventional therapies.
Epilepsy affects over 50 million people worldwide, and for one-third of these patients, medications offer no relief. Surgery is not a viable option when seizures originate in critical areas of the brain involved in essential functions such as speech, movement or vision. Traditional brain stimulation techniques like those targeting the anterior nucleus of the thalamus have had limited success.
“The existing FDA-cleared therapy targets only one portion of the thalamus, the anterior nucleus,” lead author Arianna Damiani, a graduate student researcher at Pitt’s Rehab Neural Engineering Laboratories (RNEL), said in a news release. “We hypothesized that electrical stimulation of the brain would be more effective if we could target the specific area of the thalamus most strongly connected to the seizing areas of the cerebral cortex.”
To test this hypothesis, the research team, comprising physicians, neuroscientists and bioengineers, mapped the seizure activity of 41 patients with drug-resistant epilepsy. By utilizing advanced imaging and brain recordings, they identified the precise brain connections between seizure-prone areas of the cerebral cortex and specific locations within the thalamus.
When this personalized DBS was applied, the results were groundbreaking. Patients experienced a dramatic decrease in the number and severity of their seizures. For long-term implant recipients, seizure frequency plummeted by nearly 90%, with some patients experiencing months-long seizure-free periods.
“This is a major step toward making brain stimulation more effective for people with treatment-resistant epilepsy,” Damiani added. “This isn’t just a treatment, this is your treatment.”
This study is distinct because it integrates multiple techniques — electrical stimulation, imaging and clinical assessment — within the same patient cohort. Such a comprehensive approach had not been attempted in prior research.
“The epilepsy monitoring unit at UPMC Presbyterian is like few others in the world,” added co-author Jorge Gonzalez-Martinez, a UPMC neurosurgeon and director of the epilepsy surgery service. “This technology allowed us to create a novel framework for collecting and analyzing data that ultimately resulted in hyper-personalized treatments for our patients. The combination of high clinical expertise with cutting edge science is what makes significant clinical advancements possible.”
The potential of this precise targeting method extends beyond epilepsy. In the past, the Pitt/UPMC team successfully used similar DBS techniques to restore arm mobility in patients with partial paralysis due to traumatic brain injury and stroke. The researchers believe this approach could also benefit individuals suffering from psychiatric disorders, such as depression or addiction.
“We’re understanding more and more about the common mechanisms underlying many conditions that originate in the brain,” added co-senior author Elvira Pirondini, who is also with RNEL. “With both stroke and epilepsy, we targeted an area deep in the brain that is connected to the motor cortex. The difference was whether we wanted to potentiate activity or suppress it.”
Source: University of Pittsburgh