# Refractory Status Epilepticus Treated With Bilateral Pulvinar Deep Brain Stimulation—A Case Study

## TL;DR

A 30-year-old man with treatment-resistant seizures showed improvement after deep brain stimulation targeting the pulvinar thalami.

## Contribution

This case demonstrates the potential of pulvinar DBS for refractory status epilepticus when seizures are localized to posterior brain regions.

## Key findings

- Bilateral pulvinar DBS reduced seizure burden in a patient with cryptogenic NORSE.
- Seizure localization guided the selection of the pulvinar as a neuromodulation target.
- Clinical improvement was observed following DBS, suggesting its efficacy in refractory cases.

## Abstract

New‐onset refractory status epilepticus (NORSE) arises without an identifiable cause or prior epilepsy history, with a 16%–27% mortality rate and significant long‐term neurological sequelae. Neuromodulation such as deep brain stimulation (DBS) targeting the anterior and centromedian thalamic nuclei has shown promise when the traditional approach of anti‐seizure medications (ASMs), anesthetics, and immunomodulation fails. We present a case of cryptogenic NORSE in a 30‐year‐old male with autism and developmental delay, with refractory seizures localized to bilateral posterior quadrants. Sensing‐enabled DBS targeting the pulvinar thalami led to decreased seizure burden and clinical improvement, highlighting the importance of tailoring neuromodulatory targets to seizure localization.