case_images: PMC9164300_01
case_images: Interictal and ictal EEG recording. (A) Generalized spike/polyspike and wave discharges. (B) Generalized onset clonic-tonic-clonic seizure. The seizure starts 2 s into the tracing and is seen in the continuation of the EEG in the lower panel, with evident clonic myogenic artifact near the end of the recording. This activity was preceded by recurrent bursts of generalized spike/polyspike and wave discharges. Longitudinal bipolar montage left over right.
case_images: fnhum-16-858413-g001.jpg
case_images: PMC9164300_01_fnhum-16-858413-g001.jpg
case_images: F1
case_images: One generalized onset clonic-tonic-clonic seizure was recorded with clonic activity of both arms, bilateral eyelid twitching, and late left head turning and left arm extension followed by generalized tonic-clonic activity (Figure 1).
case_images: Centromedian DBS and epilepsy biomarkers. (A) Axial (top left) and coronal (top right) sections of post-operative CT coregistered to pre-operative T1 MP-RAGE MRI, and rendered implantation (bottom). The CM and Pf nuclei are colored blue and white, respectively. Neurological orientation (left hemisphere is left). The estimated VTA (red) based on stimulation parameters at last follow-up (VTA modeling with Lead-DBS SimBio/FieldTrip). (B) Interictal generalized spike and wave discharges. (C) Raster plot of epileptiform discharges during initial 30 min of stage N2 sleep at baseline and with CM DBS. (D) Seizure rate at baseline over the 6-months preceding DBS, and during 1 year of follow up with CM DBS. CM, centromedian; DBS, deep brain stimulation; MP-RAGE, magnetization-prepared rapid gradient echo; Pf, parafascicular; VTA, volume of tissue activated.
case_images: fnhum-16-858413-g002.jpg
case_images: PMC9164300_01_fnhum-16-858413-g002.jpg
case_images: F2
case_images: PC-Activa  implantable pulse generator. Postoperative head CT coregistered to preoperative MRI demonstrated good positioning (Figure 2), using the Lead-DBS imaging package)1 and Morel atlas structures ( demonstrated well positioned leads (Figure 2). Electrode positions were planned using indirect AC-PC offsets and volumetric thalamus atlas structures warped into the patient's imaging space (Figure 2). Over the next 6 months the program voltage was gradually increased to 4.5 V (therapy current: left lead 4.9 mA, right lead 4.3 mA) (Figure 2). There was an apparent reduction in IED rate at follow up with CM DBS (Figure 2).