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Thalamocortical hodology to personalize electrical stimulation for focal epilepsy

Author

Listed:
  • Arianna Damiani

    (University of Pittsburgh
    University of Pittsburgh)

  • Sirisha Nouduri

    (University of Pittsburgh
    University of Pittsburgh)

  • Jonathan C. Ho

    (University of Pittsburgh
    University of Pittsburgh)

  • Steven Salazar

    (University of Pittsburgh)

  • Aude Jegou

    (University of Pittsburgh)

  • Jiahao Jay Chen

    (University of Pittsburgh)

  • Eliza Reedy

    (University of Pittsburgh)

  • Naoki Ikegaya

    (University of Pittsburgh
    Yokohama City University Graduate School of Medicine)

  • Sridevi Sarma

    (Johns Hopkins University
    Johns Hopkins University)

  • Thandar Aung

    (University of Pittsburgh
    University of Pittsburgh Medical Center)

  • Elvira Pirondini

    (University of Pittsburgh
    University of Pittsburgh
    University of Pittsburgh
    University of Pittsburgh)

  • Jorge A. Gonzalez-Martinez

    (University of Pittsburgh
    University of Pittsburgh)

Abstract

Thalamic electrical stimulation offers a therapeutic approach for refractory epilepsy patients ineligibles for resective surgery. Yet, there is currently no consensus on the optimal stimulation site. We hypothesized that targeting thalamic nuclei with precise anatomical and functional connections (hodological matching) to cortical seizure onset zones (SOZs) could enhance neuromodulatory effects. Thus, we examined three subnuclei (pulvinar, anterior, and ventral intermediate/oral posterior, VIM/VOP) in 41 focal epilepsy patients. Combining neuroimaging and electrophysiology, we identified hodologically-matched targets: pulvinar for posterior-quadrant and temporal SOZs, anterior for frontotemporal, and VIM/VOP for rolandic. Analysis of 274 seizures revealed the critical role of matched nuclei in seizure termination. Stimulation of hodologically-matched (but not unmatched) nuclei immediately suppressed interictal epileptiform discharges. Finally, in 10 chronically implanted patients, matched stimulation substantially reduced seizure frequency (87.5%), compared to unmatched targets (8.3%) over time. Our results underscore the potential of hodological thalamic targeting to modulate epileptiform activity in focal epilepsy.

Suggested Citation

  • Arianna Damiani & Sirisha Nouduri & Jonathan C. Ho & Steven Salazar & Aude Jegou & Jiahao Jay Chen & Eliza Reedy & Naoki Ikegaya & Sridevi Sarma & Thandar Aung & Elvira Pirondini & Jorge A. Gonzalez-M, 2025. "Thalamocortical hodology to personalize electrical stimulation for focal epilepsy," Nature Communications, Nature, vol. 16(1), pages 1-18, December.
    • Handle: RePEc:nat:natcom:v:16:y:2025:i:1:d:10.1038_s41467-025-64922-w
    DOI: 10.1038/s41467-025-64922-w
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    References listed on IDEAS

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    1. Nicolas Roehri & Francesca Pizzo & Fabrice Bartolomei & Fabrice Wendling & Christian-George Bénar, 2017. "What are the assets and weaknesses of HFO detectors? A benchmark framework based on realistic simulations," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-20, April.
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