Combination of Deep Brain Stimulation and Responsive Neurostimulation for the Treatment of Drug-resistant, Neuromodulation-resistant Epilepsy
Abstract number :
1.323
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2204334
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:24 AM
Authors :
Jimmy Yang, MD – The Ohio State Wexner Medical Center; Katie Bullinger, MD, PhD – Neurology – Emory University; Abdulrahman Alwaki, MD – Neurology – Emory University; Ioannis Karakis, MD, PhD, MSc – Neurology – Emory University; Brian Cabaniss, MD – Neurology – Emory University; Jessica Shields, MD, PhD – Neurosurgery – Emory University; Henry Skelton, BS – Neurosurgery – Emory University; Jon Willie, MD, PhD – Neurosurgery – Washington University; Robert Gross, MD, PhD – Neurosurgery – Emory University
Rationale: Neuromodulation is an important treatment modality for patients with drug-resistant epilepsy who are not candidates for destructive procedures. However, randomized controlled trials and real-world studies reveal that a small fraction of patients will experience minimal reduction or even an increase in seizure frequency after neuromodulation. We describe our experience with patients who underwent a second neuromodulation procedure after unsatisfactory initial response to neuromodulation. This included both patients who were either treated concurrently with multiple forms of neuromodulation or transitioned between neuromodulatory devices.
Methods: We performed a retrospective chart review to identify all patients who underwent deep brain stimulation (DBS) or responsive neurostimulation (RNS) at our center, followed by additional neuromodulatory procedures. Demographic and clinical data, including seizure frequencies, were collected.
Results: Six patients were treated with concurrent DBS of the anterior nucleus of the thalamus (ANT) and RNS. Two of these patients had previously been treated with vagus nerve stimulation (VNS), and continued VNS treatment while being treated with DBS and RNS. Five of the six patients were initially treated with RNS, followed by ANT DBS._x000D_
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Of the six patients treated concurrently with DBS and RNS, four experienced additional reduction in seizure frequency after implantation of the additional neuromodulation system (seizure frequency reductions: 9%, 27%, 113%, 177%). The remaining two patients did not experience benefit from the additional neuromodulation (seizure frequency increases: 39% and 200%). Range of follow-up for these six patients was 42 to 897 days (median: 184 days). _x000D_
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Three patients transitioned between ANT DBS and RNS. Two of these patients were initially treated with RNS, followed by DBS. Two of the three of these patients experienced further reduction in seizure frequency (8% and 25%), while one patient did not have further benefit. Follow-up for these patients from their last procedure was 377, 1029, and 1968 days.
Conclusions: For patients who do not experience substantial benefit from an initial treatment with RNS or DBS, the addition of a second neuromodulation system or switching to a different form of neuromodulation may allow for additional reduction in seizure frequency. The combination of DBS and RNS may also allow the unique benefits of each form of neuromodulation to be leveraged in the same patient. Larger studies will need to be performed to better understand whether the use of multiple systems concurrently leads to improved clinical results in patients who are initially treatment-resistant to neuromodulation.
Funding: None
Surgery