CASE REPORT article
Front. Hum. Neurosci.
Sec. Brain Imaging and Stimulation
Volume 19 - 2025 | doi: 10.3389/fnhum.2025.1663280
Deep brain stimulation of the anterior nucleus of the thalamus for seizures after new-onset refractory status epilepticus: A case report
Provisionally accepted
Ryota Sasaki1
Hiroya Ohara2
Masako Kinoshita3*
Takahiro Iizuka4
Kentaro Tamura5Kiyoshi Nagata5
Ichiro Nakagawa1- 1Nara Kenritsu Ika Daigaku Igakubu Igakuka Daigakuin Igaku Kenkyuka Noshinkei Geka, Kashihara, Japan
- 2Minami Nara Sogo Iryo Center, Yoshino, Japan
- 3Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan
- 4Kitasato Daigaku Byoin Noshinkei Naika, Sagamihara, Japan
- 5Kokuritsu Byoin Kiko Nara Iryo Center, Nara, Japan
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Objectives: Most patients with new-onset refractory status epilepticus (NORSE) subsequently develop drug-resistant epilepsy (DRE) with multiple seizure foci and are not the typical candidates for resective surgery. We report the first case of DRE developing after cryptogenic-NORSE (C-NORSE) that was successfully treated using deep brain stimulation targeting the anterior nucleus of the thalamus (ANT-DBS). Methods: A 52-year-old man developed C-NORSE at the age of 45 years and presented with sequelae of DRE and cognitive dysfunction despite anti-seizure medications and immunotherapy administration. Seizure semiology comprised palpitations, chills, and nausea, followed by impairment of awareness with oral automatism multiple times a day. Video-electroencephalogram monitoring (vEEG) showed bilateral independent electrographic seizures (ESz) in the frontotemporal areas. He underwent ANT-DBS. Preoperative and postoperative vEEG recordings for 3 days were compared. Results: Preoperative vEEG showed 11 clinical seizures correlated with ESz. The duration of ESz ranged from 55 to 213 s (median, 81 s). Three months after ANT-DBS stimulation, vEEG showed four subclinical ESz episodes lasting from 22 to 31 s (median, 25.5 s) (Mann-Whitney U test, p = 0.001). The patient had not developed an overt clinical seizure until the last follow-up at nine months. No adverse events were observed during treatment. Conclusions: ANT-DBS is an effective treatment option for DRE after NORSE, particularly when the epileptogenic network is located in the temporal lobe. A detailed evaluation using vEEG is useful for identifying the epileptogenic foci and assessing therapeutic outcome. Immunomodulatory mechanisms via cytokines could play roles in the pathogenesis of development of DRE after NORSE and seizure suppression effect of ANT-DBS.
Keywords: New-onset refractory status epilepticus, Norse, Anterior nucleus of thalamus deepbrain stimulation, DBS, Drug-resistant epilepsy, Immunotherapy, Video-electroencephalogrammonitoring, Temporal Lobe Epilepsy
Received: 11 Jul 2025; Accepted: 06 Oct 2025.
Copyright: © 2025 Sasaki, Ohara, Kinoshita, Iizuka, Tamura, Nagata and Nakagawa. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Masako Kinoshita, machak@kuhp.kyoto-u.ac.jp
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