Noninvasive Brain Stimulation as a Focal Epilepsy Treatment in the Hospital, Clinic, and Home
Abstract number :
1.214
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2023
Submission ID :
80
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Karimul Islam, M.B.B.S. – Mayo Clinic
Keith Starnes, MD – Assistant Professor, Neurology, Mayo Clinic; Kelsey Smith, MD – Assistant professor, Neurology, Mayo Clinic; Nicholas Gregg, MD – Assistant Professor, Neurology, Mayo Clinic; Alejandro A. Rabinstein, MD – Professor, Neurology, Mayo Clinic; Gregory A. Worrell, MD,PhD – Professor, Neurology, Mayo Clinic; Brian N. Lundstrom, MD,PhD – Assistant Professor, Neurology, Mayo Clinic
Rationale: Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are noninvasive brain stimulation (NIBS) approaches that are potential therapeutic tools for drug resistant focal epilepsy patients. tDCS shows promise for at-home treatment. These low-risk approaches may reduce cortical excitability and provide additional treatment options for patients who are not eligible for or decline surgical intervention.
Methods: A retrospective chart review identified drug resistant focal epilepsy patients who received NIBS in the inpatient setting, outpatient clinic, or home. For TMS, 1 Hz stimulation was applied over the seizure focus for 30 minutes at 80-120% of resting motor threshold. Each patient underwent five sessions of stimulation over one week. For outpatient tDCS, 2mA cathodal direct current stimulation was applied for 30-minute sessions on five consecutive days. Patients had the option to continue treatment at home. For inpatient tDCS, 3 mA cathodal direct current stimulation was applied for 30-minute sessions on three consecutive days. For outpatient cohorts, the seizure frequency was measured one month after the stimulation. For the tDCS inpatient cohort, seizure burden was assessed by comparing continuous EEG recordings one day before stimulation and one to three days following the completion of stimulation. Patients with at least 50% reduction in seizure frequency compared to baseline were defined as responders.
Results: Twenty-three drug resistant focal epilepsy patients (11 women and 12 men) were included. The median age at first day of brain stimulation was 40 years (range: 15 to 73). Six patients had prior surgical intervention and eight patients had prior device implants (six VNS, one RNS, and one DBS-ANT). The median number of anti-seizure medications previously tried was 6. Baseline median seizure frequency was 12 seizures per month (sz/mo; IQR = 3.25-72.5). Median seizure reduction following stimulation was 50% (IQR = 27%-100%, P= 0.0026). Thirteen patients (57%) were responders to treatment (TMS = 4/10, tDCS Outpatient = 6/8, tDCS Inpatient = 3/5). No unanticipated adverse events were reported. One patient reported transient facial pain during TMS, and another reported a transient headache after TMS. Two patients experienced an increase in seizure frequency following stimulation (one in TMS cohort and one in tDCS-outpatient cohort), which returned to baseline after stimulation treatments were discontinued.
Conclusions: TMS and tDCS are promising treatment approaches for treating drug resistant focal epilepsy patients. They have a favorable safety profile with minimal adverse effects and may be suitable in various clinical settings.
Funding: BNL was supported by NIH NINDS (K23NS112339).
Clinical Epilepsy