Abstracts

Rationale: About one-third of all patients diagnosed with epilepsy will become medically intractable with seizures that cannot be controlled with medication. In this difficult group of patients the chances to become seizure free just with medication becomes less than 5%. Epilepsy surgery with resection of the epileptogenic area is the best option. However, not all patients with intractable epilepsy have epileptogenic zones that can be resected. In cases like these, Responsive Neuro Stimulator (RNS) therapy, a palliative procedure, is an option. Methods: We reviewed the electronic medical charts of all the three patients’ who had RNS. This study was approved by the IRB. We obtained demographics, type of epilepsy, therapeutic history including dietary, VNS, and medications used their pre surgical work up data, RNS procedure history, and adverse effects. Results: We implanted the RNS device in three patients and studied them over 6 months post RNS placement and performed descriptive analyses. All three were similar in the sense that we were unable to resect their epileptogenic zone, but each for a unique reason. Patient one had her epileptogenic region in an eloquent area, right leg area, identified by intracranial monitoring with grids and depth placement. We placed two RNS depth electrodes in her right leg area. Patient two had previously had left temporal lobectomy and started have recurrence of seizures. The seizures appeared to be coming from the right temporal frontal region. We implanted one 4 contact depth electrode in the right hippocampus and one 4 contact strip over the inferior right frontal gyrus.  Patient three had bilateral symmetrical occipital lesions and two of his pre surgical workups showed seizures coming from both sides of the brain from perilesional areas, which made him a non-candidate for epilepsy surgery. We implanted 4 contact strips on either side of the brain over the lesions.  After 6 months post RNS placement, we saw positive results across the board, including decrease in seizure frequency and severity. We also noted that each patient had no side-effects post-surgery. There were fewer ICU visits, emergency department visits, and unplanned hospitalizations. Even though resective epilepsy surgery is a cure for medically intractable epilepsy, it is not an option for everyone, so there are different cures. Recently, RNS was approved by FDA, a closed loop neuromodulator. The device identifies the seizure and stimulates the brain at the seizure onset zone. Unfortunately, RNS therapy is not FDA approved for patients less than 18 years of age. We implanted RNS in three of our patients with medically intractable epilepsy on a compassionate care. All three patients’ tolerated the procedure well with no adverse events. Their seizure frequency dropped and became less sever. Conclusions: We conclude that RNS therapy is a safe and effective option for pediatric patients who are not candidates for resective epilepsy surgery. Funding: None