# Thalamic stimulation to prevent impaired consciousness in epilepsy

> **NIH NIH UH3** · YALE UNIVERSITY · 2022 · $1,801,916

## Abstract

PROJECT SUMMARY / ABSTRACT
Impaired consciousness during seizures has a major negative impact on quality of life for people with epilepsy.
Consequences include risk of motor vehicle accidents, drowning, poor work and school performance, and
social stigmatization. Impaired ictal/postictal arousal may also compromise breathing leading to sudden
unexpected death in epilepsy. Although the primary goal of epilepsy care is to stop seizures, restoring
conscious awareness in patients whose seizures cannot be stopped (by medications, surgery or deep brain
stimulation) could significantly improve outcome. Disorders of consciousness other than epilepsy have long
been known to arise from dysfunction of subcortical-cortical arousal circuits. Deep brain stimulation (DBS) of
the thalamic intralaminar central lateral nuclei (CL) is a promising approach to restore conscious arousal
currently being trialed for chronic disorders of consciousness (N. Schiff, NINDS UH3 NS095554). Recent
neuroimaging and EEG studies have shown that transient impaired consciousness in temporal lobe epilepsy
(TLE) seizures also depends on subcortical-cortical arousal including thalamic CL. Translational studies from
our research group further demonstrate depressed CL function in limbic seizures, and most importantly that
thalamic CL stimulation has the potential to restore physiological and behavioral arousal in the ictal and
postictal periods. DBS treatment of epilepsy has advanced rapidly with FDA approval of responsive
neurostimulation (RNS, NeuroPace) and thalamic anterior nucleus stimulation (Medtronic). Investigational
devices such as the RC+S (Medtronic) provide a unique opportunity for responsive stimulation of up to 4
separate brain regions, enabling conventional sites such as hippocampus (HC) to be combined with innovative
targets such as thalamic CL. Meanwhile, Dr. Worrell’s group at Mayo has developed the Epilepsy Personal
Assistant Device (EPAD), a custom application running on a hand-held device with bi-directional
communication with the RC+S. The EPAD will enable cloud-based data storage, seizure diaries, and automatic
behavioral tests similar to those we have validated previously. Therefore, our goal is to develop and pilot test
the feasibility and safety of bilateral thalamic CL stimulation using RC+S to restore conscious arousal in TLE
seizures which are not stopped by conventional responsive neurostimulation, offering hope to greatly improve
quality of life in these patients. Our aims are to first conduct final benchtop preclinical verification of RC+S and
EPAD algorithms for CL stimulation leading to FDA IDE approval. Second, we will initiate a small clinical trial
implanting RC+S in patients with refractory TLE and beginning with open-label HC stimulation and baseline
EPAD behavioral testing. Third, we will adjust responsive thalamic CL stimulation parameters for arousal.
Finally, we will test safety and initial feasibility of responsive CL stimulation to restore ar...

## Key facts

- **NIH application ID:** 10477293
- **Project number:** 5UH3NS112826-04
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** HAL BLUMENFELD
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $1,801,916
- **Award type:** 5
- **Project period:** 2019-09-15 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10477293

## Citation

> US National Institutes of Health, RePORTER application 10477293, Thalamic stimulation to prevent impaired consciousness in epilepsy (5UH3NS112826-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10477293. Licensed CC0.

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