Abstracts

Rationale: A growing body of evidence suggests that neuromodulation therapies complement other medical and surgical interventions to improve seizures and cognition in people with epilepsy (POW). However, there is a significant service gap in integrating these therapies in patient management including availability of trained physicians to perform implantation, programming or troubleshooting the device, appropriate patient selection and educating them for informed decision making. Additionally, there is a knowledge gap in understanding practice variations and therapeutic effectiveness of some of the newer approved therapies (like Neuropace and Medtronic DBS). To overcome these limitations, our level-IV epilepsy center has taken an innovative approach by establishing an epilepsy neuromodulation clinic (hub) that offers a full array of services and anchors a network of secondary establishments (spokes) distributed within the gulf coasts region. Herein, we report our outcome accomplished over a year in this highly specialized clinic. Objectives: To report a) treatment outcome of VNS and RNS; b) demonstrate benefits of a specialized clinic (rapid titration, superior access for patient and vendors); c) efficient recruitment for research studies; d) increase referrals for potential neuromodulation therapy; and e) education of future providers. Methods: This is a single-center retrospective study. We reviewed electronic medical records of all patients followed in the clinic from January 1, 2017, till Jan 1, 2018. Data regarding patient demographics, seizure characteristics, pre-surgical workup, time from referral to implantation, stimulation titration schedule, and complications or side effects were collected. Results: 23 patients with VNS and 17 patients with RNS were followed in the clinic over the span of 12 months. For VNS, mean age of patients  34.2 yrs (R= 19-60), meantime from referral to VNS surgery (implantation or battery replacement) was 4.07 mo (R= 2-15),  first appointment post-implant was 2 wks (R= 1-3) , and time from first clinic visit to maximum tolerated dose (1.25-1.75 mAmp) was 6 wks (R= 4-15) weeks. 40% of the cohort were responders. Complications included stimulus-related temporary voice changes and cough. For RNS, mean age 38 yrs (R=21-60), eloquent cortex implant (N=5), and a significant decrease in seizure over 75%. 26% of VNS and 17% of RNS patients were followed in spokes. At any given time multiple research (N=2-4) were active with recruitment over 48%. Multiple residents, fellows, NP and junior faculty rotated in the clinic to gain hands-on experience. Conclusions: Neuromodulation clinic has shown to serve as an optimal solution for patients as well as providers due to easy access, improved care with the rapid titrating, and prompt follow up appointments in case of complications. Physicians can closely monitor patient’s clinical course, assess the efficacy of stimulator used, recruit appropriate patients for clinical trials to advance science, and use this clinic as a resource to educate and train future specialist related to this field. Funding: Not applicable