JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL

Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas

Barbara C Jobst, Ritu Kapur, Gregory L Barkley, Carl W Bazil, Michel J Berg, Gregory K Bergey, Jane G Boggs, Sydney S Cash, Andrew J Cole, Michael S Duchowny, Robert B Duckrow, Jonathan C Edwards, Stephan Eisenschenk, A James Fessler, Nathan B Fountain, Eric B Geller, Alica M Goldman, Robert R Goodman, Robert E Gross, Ryder P Gwinn, Christianne Heck, Aamr A Herekar, Lawrence J Hirsch, David King-Stephens, Douglas R Labar, W R Marsh, Kimford J Meador, Ian Miller, Eli M Mizrahi, Anthony M Murro, Dileep R Nair, Katherine H Noe, Piotr W Olejniczak, Yong D Park, Paul Rutecki, Vicenta Salanova, Raj D Sheth, Christopher Skidmore, Michael C Smith, David C Spencer, Shraddha Srinivasan, William Tatum, Paul Van Ness, David G Vossler, Robert E Wharen, Gregory A Worrell, Daniel Yoshor, Richard S Zimmerman, Tara L Skarpaas, Martha J Morrell
Epilepsia 2017, 58 (6): 1005-1014
28387951

OBJECTIVE: Evaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with medically intractable partial-onset seizures of neocortical origin.

METHODS: Patients with partial seizures of neocortical origin were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. Additional analyses considered safety and seizure reduction according to lobe and functional area (e.g., eloquent cortex) of seizure onset.

RESULTS: There were 126 patients with seizures of neocortical onset. The average follow-up was 6.1 implant years. The median percent seizure reduction was 70% in patients with frontal and parietal seizure onsets, 58% in those with temporal neocortical onsets, and 51% in those with multilobar onsets (last observation carried forward [LOCF] analysis). Twenty-six percent of patients experienced at least one seizure-free period of 6 months or longer and 14% experienced at least one seizure-free period of 1 year or longer. Patients with lesions on magnetic resonance imaging (MRI; 77% reduction, LOCF) and those with normal MRI findings (45% reduction, LOCF) benefitted, although the treatment response was more robust in patients with an MRI lesion (p = 0.02, generalized estimating equation [GEE]). There were no differences in the seizure reduction in patients with and without prior epilepsy surgery or vagus nerve stimulation. Stimulation parameters used for treatment did not cause acute or chronic neurologic deficits, even in eloquent cortical areas. The rates of infection (0.017 per patient implant year) and perioperative hemorrhage (0.8%) were not greater than with other neurostimulation devices.

SIGNIFICANCE: Brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including adults with seizures of neocortical onset, and those with onsets from eloquent cortex.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
28387951
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.