Erratum. Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008–present)

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TO THE READERSHIP: An error appeared in the article by Zhou et al. (Zhou JJ, Chen T, Farber SH, et al: Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade [2008–present]. Neurosurg Focus 45[2]:E5, 2018).

In the left column of Table 1, the first group named “Amygdala” was incorrect. This group should be “ANT” for “anterior nucleus of the thalamus.” Also, for the study by Krishna et al. (2016), the DBS response rate of 11/14 has been changed to 11/16 to reflect the original article. The

TO THE READERSHIP: An error appeared in the article by Zhou et al. (Zhou JJ, Chen T, Farber SH, et al: Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade [2008–present]. Neurosurg Focus 45[2]:E5, 2018).

In the left column of Table 1, the first group named “Amygdala” was incorrect. This group should be “ANT” for “anterior nucleus of the thalamus.” Also, for the study by Krishna et al. (2016), the DBS response rate of 11/14 has been changed to 11/16 to reflect the original article. The corrected table appears on the following pages.

TABLE 1.

Summary of literature review findings

Target/Authors & YearStudy TypeNo. of PtsTargetStimulation ParametersFU DurationDBS Response RateOther OutcomesAdverse Events
ANT
Lim et al., 2008CS4Bilat ANT4–5 V; 90–110 Hz; 60–90 μsec; continuous/ intermittent2 yrs50% (2/4)1 pt developed asymptomatic hemorrhage; 1 pt developed erosion of extension wire through scalp, requiring surgical repair
Andrade et al., 2010CS1ANTNot described9.5–10 yrs50% (1/2)No changes in behavior or cognitive statusNone described
Fisher et al., 2010 (SANTE trial)RCT110Bilat ANT5 V; 145 Hz; 90 μsec; intermittent (1 on, 5 off)24 mos53% (43/81)Stimulated participants were more likely to report depression or memory impairment as adverse events during the blinded phase12.7% of pts developed infections (7.3% stimulator pocket, 5.5% lead extensions, 1.8% bur hole), & 8.2% required removal of hardware; 8.2% of pts required lead repositioning; 4.5% of pts developed asymptomatic hemorrhage; 1 participant developed status epilepticus associated w/ stimulation
Lee et al., 2012CS15Bilat ANT1.5–3.1 V; 100–185 Hz; 90–150 μsec; continuous24–67 mos87% (13/15)1 pt developed wound infection requiring explantation
Oh et al., 2012CS9Bilat ANT1.5–3.1 V; 100–185 Hz; 90–150 μsec; continuousMean 15.9 mos78% (7/9)Improved performance in verbal fluency tasks & delayed verbal memory after ANT DBS; improvement not correlated to Sz reduction. No significant changes in IQ, MMSE score, information processing, or executive function. No significant cognitive decline after DBSNone described
Penn et al., 2012CR1Bilat ANTNot described10 mosNAPt developed Twiddler syndrome, requiring revision of IPG & extension wires. After revision op, pt developed a wound infection requiring explantation
Hartikainen et al., 2014CT12Bilat ANT5 mA; 145 Hz; continuousNANAANT DBS stimulation increased the frequency of commission errors & slowed reaction time in the presence of threat-related distractorsNone described
Bucurenciu et al., 2015CR1Bilat ANT3–7.5 V; 145–180 Hz; 90–120 μsec; intermittent (1 min on, 5 mins off to 20 sec on, 20 sec off)11 mosNAStimulation voltages >3 V were associated w/ subclinical Szs in the anterior & temporal regionsNone described
Cukiert et al., 2015CS6ANT5 V; 130 Hz; 300 μsec; continuousUp to 6 mos after battery depletion100% (9/9)1 pt did not experience increased Sz frequency after battery depletion; 5 pts experienced increased Sz frequency after battery depletion, 3 of whom had lower Sz frequency than at pre-DBS baseline, while 2 returned to pre-DBS baselineNone described
Piacentino et al., 2015CS6ANT4 V; 140 Hz; 90 μsec; not specified24 mos50% (3/6)1 pt died 40 days postop due to a myocardial infarction (unrelated to op)None described
Salanova et al., 2015 (SANTE study w/ 5-yr FU)CS74Bilat ANTNot described5 yrs69% (51/74)Significant improvement in neuropsychological testing at 5 yrs, specifically in attention, executive function, depression, tension/anxiety, total mood disturbance, & subjective cognitive function. Significant improvement in QOL (QOLIE-31) at 5 yrsImplant site infection in 12.7% of pts; 9 required full/partial system explantation. Lead not w/in target in 8.2% of pts
Van Gompel et al., 2015CS2Bilat ANT (stimulation) + bilat HCP (recording)4 V; 7–8 Hz; 90 μsec; intermittent (0.4 on, 0.1 off) or continuous12 wks100% (2/2)None described
Voges et al., 2015CS9ANT4 V; 145 Hz; 90 μsec; intermittent (1 on, 5 off)1–21 mos44% (4/9)2 pts excluded because of technical artifacts; remaining 7 pts demonstrated DBS-related arousal w/ maximal voltage. At 5 V, DBS-related arousal occurred w/ 14.0%–67.0% of all DBS stimuli. Reduction of DBS voltage to btwn 1 & 4 V led to decrease in DBS-related arousals to btwn 9.0% & 33.0% of all stimuli. Reduction of nocturnal DBS voltages resulted in no worsening of Sz frequency & incomplete/complete remission of neuropsychiatric symptomsNone described
Franco et al., 2016CS2ANT5 V; 145 Hz; 90 μsec; continuous12–18 mos100% (2/2)Both pts experienced new-onset or worsening depressive symptoms after ANT DBSNone described
Krishna et al., 2016CS16ANT2.4–7 V; >100 Hz; 90 μsec; not specified1–14 yrs (mean 4.3 ± 3.8)69% (11/16)1 pt developed a deep infection requiring explantation; 1 developed a superficial infection requiring wound revision; 1 experienced severe postop agitation requiring cessation of stimulation
Lehtimäki et al., 2016CS15Bilat ANT5 V; 140 Hz; 90 μsec; intermittent (1 on, 5 off)5 yrs67% (10/15)None described
Sweeney-Reed et al., 2016CS8Unilat/bilat ANT/DMNTNot described6 mos50% (4/8)None described
Lee et al., 2017CR1Bilat ANT8 V; 145 Hz; 120 μsec; continuous45 daysNAImmediate resolution of RSE after DBS placement & stimulation; 100% decrease in GTCS & “head nodding” events & 90% decrease in staring episodes & myoclonic jerks during FUNone described
Valentín et al., 2017CS1Bilat ANTNot described12–48 mos100% (1/1)Pt w/ bilat ANT DBS developed increased aggressionNone described
Tröster et al., 2017 (SANTE trial w/ 7-yr FU)RCT67Bilat ANTNot described7 yrsNAStimulated participants were more likely to report depression or memory impairment as adverse events, but no objective cognitive decline or worsening of depression was observed in this group during the blinded phase. No overall cognitive decline or worsening of depression scores was observed 7 yrs into the open-label period. Self-reported depression & memory impairment adverse events were not associated w/ reliable changes on objective neuropsychological measures or overall 7-yr neurobehavioral outcomeSee Fisher et al., 201015
CMT
 Cukiert et al., 2009CS4Bilat CMT2 V; 130 Hz; 300 μsec; continuous1–2 yrs100% (4/4)Clinically relevant increase in attention level in 4/4 pts after CMT DBSNone described
 Valentín et al., 2012CR1Bilat CMT5 V; 6 Hz; 90 μsec; continuous6 mosNAImmediate resolution of tonic-clonic Szs & epileptiform discharges after DBS placement & stimulation. Further resolution of myoclonic jerks 4 wks after initiation of DBSElectrodes explanted at 6 mos due to infection
 Cukiert et al., 2015CS2CMT5 V; 130 Hz; 300 μsec; continuousUp to 6 mos after battery depletion100% (2/2)1 pt did not experience increased Sz frequency after battery depletion; 1 pt experienced increased Sz frequency after battery depletion, but the frequency was lower than pre-DBS baselineNone described
 Valentín et al., 2013CT11Bilat CMT5 V; 60–130 Hz; 90 μsec; continuous12–66 mos64% (7/11)1 pt required device explantation because of infection; 1 experienced transient agraphia immediately after implantation
 Son et al., 2016CS14Unilat/bilat CMT2.2 ± 0.41 V; 129.3 ± 2.7 Hz; 124.4 ± 23.0 μsec; continuous9–25 mos79% (11/14)No correlation btwn calculated coordinates & percentage of Sz reduction1 pt required lead repositioning
 Lehtimäki et al., 2017CR1Bilat CMT7 V; 180 Hz; 150 μsec; continuous7 mosNAResolution of RSE w/ high-frequency stimulation combined w/ S-ketamine infusion; RSE returned when stimulation switched from continuous to intermittent but resolved again w/ continuous stimulation; 2–4 focal Szs per mo on continuous stimulation (baseline frequency not noted)None described
 Valentín et al., 2017CS2Bilat CMTNot described12–48 mos50% (1/2)None described
HCP
McLachlan et al., 2010CT2Bilat HCP0.5+ V; 185 Hz; 90 μsec; continuous12 mosNASubjective memory improvement in 1 pt during stimulation periodNone described
Boex et al., 2011CS8Unilat/bilat HCP/AMG0.5–2 V; 130 Hz; 450 μsec; continuous12–74 mos75% (6/8)Reversible memory impairments w/ high-voltage or quadripolar stimulation in 2 pts; otherwise, no significant neuropsychological outcomesNone described
Miatton et al., 2011CS10Unilat/bilat HCP/AMG1–2.5 V; 130 Hz; 450 μsec; continuous6 mos70% (7/10)Pts w/ both unilat & bilat HCP/AMG DBS reported significantly fewer somatic complaints & feelings of insufficient mental/physical functioning. Unilat HCP/AMG DBS in dominant hemisphere was associated w/ significantly lower verbal IQ. No overall pattern of change in cognitive measures w/ DBSNone described
Bondallaz et al., 2013CS8HCP0.5–2 V; 130 Hz; 450 µsec; continuous10–74 mos75% (6/8)1 pt required reimplantation of an electrode due to lead fracture
Vonck et al., 2013CS11Unilat/bilat HCP/AMG1–6 V; 130 Hz; 450 µsec; continuous +/- day/night cycling67–120 mos82% (9/11)1 pt had asymptomatic intracranial hemorrhage; 1 pt required cable revision due to hardware failure; 1 pt required pulse generator removal due to local infection
Cukiert et al., 2014CS9Unilat/bilat HCP1–3.5 V; 130 Hz; 300 µsec; continuous15–50 mos78% (7/9)1 pt required explantation due to infection related to trauma directly to the generator
Cukiert et al., 2015CS112 V; 130 Hz; 300 μsec; continuousUp to 6 mos after battery depletion100% (1/1)Sz frequency increased after battery depletion but was lower than pre-DBS baselineNone described
Jin et al., 2016CS3Bilat HCP1–2.5 V; 130–170 Hz; 450 μsec; continuous26–43 mos100% (3/3)No postop neuropsychological deterioration at 1 yr as measured by Wechsler Adult Intelligence Scale & Wechsler Memory ScaleNone described
Lim et al., 2016CS5Unilat/bilat HCPLow frequency: 1–6 V; 3–5 Hz; 90–120 μsec; intermittent (1 on, 5 off)30–42 mos60% (3/5)None described
Cukiert et al., 2017RCT16Unilat/bilat HCP2 V; 130 Hz; 300 μsec; continuous8 mos87.5% (7/8)2 pts presented w/ local wound erosions & were treated successfully w/ antibiotics
Other
Franzini et al., 2008CS4Bilat pHyp (2), unilat CZi (2)pHyp: 1.5–3.5 V; 185 Hz; 90 μsec; continuous6 mos–5 yrs75% (3/4)2 pts who had significant behavior comorbidity before pHyp DBS experienced dramatic improvement in disruptive behaviorNone described
Wille et al., 2011CS5Bilat SNr/STN ± bilat VIM1–4 V; 100–160 Hz; 60–120 μsec; continuous12–42 mosNAImprovement in HRQoL in 4/5 pts, predominantly in overall, energy/fatigue, & emotional well-being domains1 pt developed hardware failure due to unilat electrode dislocation
Capecci et al., 2012CS2Bilat STN2–3 V; 130 Hz; 60 μsec; continuous ± day/night cycling12–48 mos50% (1/2)Both pts exhibited neuropsychological decline w/ DBS, including worsening attention, aboulia, apathy, & mood changes. No improvement in functional status or QOL noted in either caseNone described
Koubeissi et al., 2013CS11Fornix8 mA/phase; 5Hz; 0.2 μsec; 4-hr sessions48 hrsNALFS of the fornix resulted in a significant increase in MMSE scores, mostly due to improvement in delayed recall scoresNone described
Schmitt et al., 2014CS5Bilat NAC + bilat ANT5 V; 125 Hz; 90 μsec; intermittent (1 on, 5 off)6 mos40% (2/5)No significant differences in neuropsychological measures at 6 mos: 1 pt experienced resolution of major depressive symptoms after NAC DBS & 2 pts developed new-onset generalized anxiety disorder after DBSNone described
Benedetti-Isaac et al., 2015CS5Bilat pHyp3 V; 185 Hz; 90 μsec; intermittent (1 on, 5 off)2 mos–4 yrs (mean 2.83 yrs)100% (5/5)None described
Kowski et al., 2015CT4Bilat NAC + bilat ANT5 V; 125 Hz; 90 μsec; intermittent (1 on, 5 off)15 mos75% (3/4)1 pt developed subcutaneous infection requiring explantation & reimplantation at a later date 

AMG = amygdala; CR = case report; CS = case series; CT = crossover trial; CZi = caudal zone incerta; DMNT = dorsomedial nuclei of the thalamus; FU = follow-up; GTCS = generalized tonic-clonic seizure; HRQoL = health-related quality of life; IPG = implantable pulse generator; MMSE = Mini–Mental State Examination; NA = not available; NAC = nucleus accumbens; pHyp = posterior hypothalamus; Pt = patient; QOL = quality of life; QOLIE-31 = Quality of Life in Epilepsy Inventory-31; RCT = randomized controlled trial; RSE = refractory status epilepticus; SNr = substantia nigra pars reticulata; STN = subthalamic nucleus; Sz = seizure; VIM = ventral intermediate nucleus of the thalamus.

The article has been corrected online as of November 1, 2018.

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INCLUDE WHEN CITING DOI: 10.3171/2018.9.FOCUS18161a.

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