Responsive Neurostimulation (RNS) Therapy for Patients with Focal Epilepsy Due to Malformations of Cortical Development
Abstract number :
3.156
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2019
Submission ID :
2422054
Source :
www.aesnet.org
Presentation date :
12/9/2019 1:55:12 PM
Published date :
Nov 25, 2019, 12:14 PM
Authors :
Sarah meira benchayas, University of Pittsburgh; Niravkumar Barot, University of Pittsburgh; Naoir Zaher, University of Pittsburgh; William Welch, University of Pittsburgh; James P. Castellano, University of Pittsburgh; Arun Antony, University of Pittsbur
Rationale: Malformations of Cortical Development (MCDs) are a wide-ranging group of developmental disorders which are often a cause of pharmacoresistant focal epilepsy. Surgical management can be challenging due to extensive cerebral involvement and/or lesions involving eloquent cortex. This study reports our experience with Responsive Neurostimulation (RNS) therapy in patients with extensive MCDs who were not the ideal candidate for focal surgical resection. Methods: We performed a retrospective analysis of consecutive patients who received RNS implantation from January 2015 to January 2019 at our institution. A total of 25 patients had RNS implanted during this period. Thirteen patients had pharmacoresistant focal epilepsy and at least six months of follow up, and among these, we found four patients with malformations of cortical development (MCDs). These patients with MCDs had a comprehensive presurgical evaluation, including epilepsy protocol 3 Tesla MRI brain, PET scan, Magnetoencephalogram (MEG), and stereo EEG implantation. Results: The mean age of the patients with MCDs was 34 years (range: 21-46 years). The mean duration of epilepsy was 19.5 years (range: 7-34 years). Two patients had schizencephaly (one of them associated with heterotopia (P1) and one with polymicrogyria (P2)). The third patient (P3) had bilateral periventricular heterotopias and fourth (P4) had band heterotopia. Three patients (P1, P3, P4) had two RNS depth electrodes, and one patient (P2) had two cortical strip electrodes placed along the epileptogenic zone identified by stereo EEG. Out of four patients, three reported greater than 90% reduction in seizure frequency at mean follow up duration of 31.5 months (Range: 20 -50 months), and one of them was seizure free. The fourth patient (P3) had a 50-74% reduction in seizure frequency. Conclusions: This study demonstrates that RNS implantation may be a valuable treatment strategy in pharmacoresistant focal epilepsy secondary to malformations of cortical development. Funding: No funding
Neurophysiology