{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T21:49:48Z","timestamp":1792273788597,"version":"4.4.0"},"reference-count":35,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["K23NS136792"],"award-info":[{"award-number":["K23NS136792"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n Anterior nucleus of the thalamus (ANT) deep brain stimulation (DBS) is an effective therapy for frontotemporal and limbic drug\u2010resistant focal epilepsies. The pulvinar nucleus (PUL) is an emerging neuromodulation target for seizure networks involving the posterior quadrant and temporal lobe. This study evaluates the safety and effectiveness of combined bilateral ANT plus PUL DBS for posterior quadrant and temporal lobe epilepsies.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a single\u2010center retrospective cohort study of patients receiving combined ANT\/PUL DBS between 2021 and 2025. Outcomes included median seizure rate reduction (MSR), responder rate (RR; >50% seizure frequency reduction), and stimulation\u2010related side effects, assessed across ANT, PUL, and concurrent ANT\/PUL stimulation settings. Acute surgical complications were evaluated. Statistical significance was assessed using two\u2010sided Wilcoxon signed\u2010rank tests with Holm\u2013Bonferroni correction.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Nine patients with combined ANT\/PUL DBS were identified, and eight patients had sufficient follow\u2010up for inclusion (median follow\u2010up\u2009=\u200920\u2009months). Posterior predominant structural abnormalities were present in eight of nine patients. There were no acute surgical complications. Three instances of transient stimulation\u2010related side effects resolved with parameter adjustments, whereas one patient required rescue antiseizure medication in addition to programming changes. Eight patients received periods of ANT stimulation, six PUL stimulation, and seven combined ANT\/PUL stimulation. Regarding overall outcome, at last follow\u2010up, there was a significant 80.8% MSR (\n p<\/jats:italic>\n \u2009=\u2009.0078) and 87.5% RR, with two patients receiving ANT and six ANT\/PUL stimulation. Regarding target\u2010specific MSR, concurrent ANT\/PUL DBS (68.8% MSR) showed a trend toward superior performance relative to ANT (43.3%) and PUL DBS (17.5%) alone, although subgroup analysis of target\u2010specific performance did not reach statistical significance.\n <\/jats:p>\n <\/jats:sec>\n \n Significance<\/jats:title>\n Combined four\u2010lead ANT\/PUL DBS appears safe and effective for patients with drug\u2010resistant posterior quadrant and temporal lobe epilepsies. Dual\u2010network neuromodulation may provide greater flexibility to individually optimize neuromodulation for complex seizure networks.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/epi.70416","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T10:15:32Z","timestamp":1785579332000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pulvinar and anterior nucleus of the thalamus dual\u2010network neuromodulation for complex epilepsies"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1936-0861","authenticated-orcid":false,"given":"Gloria","family":"Ortiz\u2010Guerrero","sequence":"first","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asra","family":"Tanwir","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"},{"name":"Department of Neurology University of Oklahoma Oklahoma City Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashar","family":"Farooqi","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"},{"name":"Department of Neurology University of Kentucky Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6371-265X","authenticated-orcid":false,"given":"Sihyeong","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamaleldin","family":"Osman","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Starnes","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5310-5549","authenticated-orcid":false,"given":"Brian N.","family":"Lundstrom","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2916-0553","authenticated-orcid":false,"given":"Gregory A.","family":"Worrell","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6687-6422","authenticated-orcid":false,"given":"Kai J.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8087-7870","authenticated-orcid":false,"given":"Jamie J.","family":"Van Gompel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6151-043X","authenticated-orcid":false,"given":"Nicholas M.","family":"Gregg","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"issue":"10","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"3347","DOI":"10.1093\/brain\/awac234","article-title":"Towards network\u2010guided neuromodulation for epilepsy","volume":"145","author":"Piper 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