Ictal connectivity changes induced by pulvinar stimulation correlate with improvement of awareness

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Deutschová, Barbora | Pizzo, Francesca | Giusiano, Bernard | Medina Villalon, Samuel | Carron, Romain | Bénar, Christian | Bartolomei, Fabrice

Edité par CCSD ; Elsevier -

International audience. In patients with epilepsy, alteration of awareness (AOA) during seizures is a disabling feature that can potentially lead to serious consequences such as falls and injuries. Regarding the neural mechanisms underlying AOA in focal seizures, some hypotheses have been put forward. In temporal lobe epilepsy, AOA has been related to the extension of the discharge to subcortical structures and to subsequent widespread inhibition (Blumenfeld and Taylor, 2003) or disturbed synchrony process (Bartolomei and Naccache, 2011) of the fronto-parietal association cortices. Thalamic stimulation was shown to be effective in reducing AOA (Gummadavelli et al., 2015). The medial pulvinar (PuM) is a thalamic nucleus often involved in focal seizures in different type of epilepsy (Pizzo et al., 2020). In a recent work (Filipescu et al., 2019), we observed that high frequency stimulation of the PuM during temporal lobe seizures could lead to improvement of awareness. Data from intracranial recordings in epileptic patients suggested that transition between conscious and non-conscious states during seizures was due to an excessive synchrony between the thalamus and associative cortices (Arthuis et al., 2009; Bartolomei and Naccache, 2011).

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