{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:15:47Z","timestamp":1792804547863,"version":"4.5.0"},"reference-count":44,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T00:00:00Z","timestamp":1721865600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although &gt;30% of epilepsy patients have drug\u2010resistant epilepsy (DRE), typically those with generalized or multifocal disease have not traditionally been considered surgical candidates. Responsive neurostimulation (RNS) of the centromedian (CM) region of the thalamus now appears to be a promising therapeutic option for this patient population. We present outcomes following CM RNS for 13 patients with idiopathic generalized epilepsy (IGE) and eight with multifocal onsets that rapidly generalize to bilateral tonic\u2013clonic (focal to bilateral tonic\u2013clonic [FBTC]) seizures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review of all patients undergoing bilateral CM RNS by the senior author through July 2022 were reviewed. Electrodes were localized and volumes of tissue activation were modeled in Lead\u2010DBS. Changes in patient seizure frequency were extracted from electronic medical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010one patients with DRE underwent bilateral CM RNS implantation. For 17 patients with at least 1\u2009year of postimplantation follow\u2010up, average seizure reduction from preoperative baseline was 82.6% (SD\u2009=\u200919.0%, median\u2009=\u200991.7%), with 18% of patients Engel class 1, 29% Engel class 2, 53% Engel class 3, and 0% Engel class 4. There was a trend for average seizure reduction to be greater for patients with nonlesional FBTC seizures than for other patients. For patients achieving at least Engel class 3 outcome, median time to worthwhile seizure reduction was 203.5\u2009days (interquartile range\u2009=\u2009110.5\u2013343.75\u2009days). Patients with IGE with myoclonic seizures had a significantly shorter time to worthwhile seizure reduction than other patients. The surgical targeting strategy evolved after the first four subjects to achieve greater anatomic accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Patients with both primary and rapidly generalized epilepsy who underwent CM RNS experienced substantial seizure relief. Subsets of these patient populations may particularly benefit from CM RNS. The refinement of lead targeting, tuning of RNS system parameters, and patient selection are ongoing areas of investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.18070","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T10:54:52Z","timestamp":1721904892000},"page":"2626-2640","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Centromedian region thalamic responsive neurostimulation mitigates\u00a0idiopathic generalized and multifocal epilepsy with focal to bilateral tonic\u2013clonic seizures"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8029-2629","authenticated-orcid":false,"given":"Pranav","family":"Nanda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Neurosurgery Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel","family":"Sisterson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Neurosurgery Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Walton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Brain and Cognitive Sciences Massachusetts Institute of Technology  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7670-9313","authenticated-orcid":false,"given":"Catherine J.","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sydney S.","family":"Cash","sequence":"additional","affiliation":[{"name":"Department of Neurology Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1191-1315","authenticated-orcid":false,"given":"Lidia M. 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