We present a case of Dravet Syndrome (DS) with drug-resistant multifocal epilepsy who we successfully treated using FDA-approved sensing-enabled Percept DBS. Our therapeutic approach involved precise targeting of multiple thalami (centromedian and pulvinar) for DBS to engage and modulate putative epileptogenic circuits.

Patient underwent DBS placement targeting the left centro-median and left pulvinar nuclei and stimulation parameters were gradually advanced during monthly follow-up. Patient experienced gradual reduction in seizure frequency and improvement in quality of life. Analysis of thalamic recordings derived from the device showed that both CM and Pulvinar presented significant circadian as well as multi-day cyclicity. We were also able to show that high-frequency stimulation of CM and Pulvinar modulates thalamic neural activity.

This pioneering case study unveils a groundbreaking exploration of DS by delving into the intricacies of SCN1A channelopathy. It marks the first-ever documentation of seizure cycles, seizure clusters, and thalamic recordings in this context and underscores the immense potential of thalamic neuromodulation in alleviating the formidable seizure burden associated with DS. This case signifies progress in circuit-based therapeutics and automated seizure burden monitoring for severe channelopathies.