Responsive Neurostimulation (RNS) in Patients with Epilepsy During the COVID-19 Pandemic
Abstract number :
2.179
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2023
Submission ID :
703
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Joanne Lau, MD, MS – University of California, San Diego / Department of Neurosciences
Leena Kansal, MD – Neurosciences – University of California, San Diego; David Lee, MD, PhD – Neurosciences – University of California, San Diego; Jerry Shih, MD – Neurosciences – University of California, San Diego
Rationale: Using Responsive Neurostimulation (RNS) biomarkers, we aimed to evaluate the longitudinal impact of the COVID-19 pandemic on the care of patients with epilepsy. Prior research on the impact of the pandemic on patients with epilepsy demonstrated mixed results with findings of an increase, decrease, or no change in seizure frequency during the pandemic. A study that used weekly long episode counts (LECs) from RNS as a proxy measure for seizure frequency found that most patients did not have an increase in seizures during the first six months of the pandemic, and observed no correlation between pandemic-related stress and seizure frequency. Our retrospective observational study sought to extend this investigation for a longer period of time, up to one year, and also utilized additional RNS biomarkers. A secondary objective was to investigate whether RNS biomarker activity correlated with other factors that influence seizure control such as changes to anti-seizure medications and number of clinic visits.
Methods: Weekly LECs, saturation, and magnet swipes were used as proxy measures for evaluation of seizure activity up to one year before and one year after the COVID-19 pandemic was declared on March 2020. Paired Wilcoxon signed-rank test was used to determine if there was a significant difference in the mean outcomes pre and post COVID-19 pandemic declaration. Chart review was also conducted to collect information such as RNS implantation date, seizure type, self-reported seizure frequency, number of in-person clinic and telemedicine visits, COVID-19 infection dates, anti-seizure medication regimen, and changes to RNS program settings.
Results: A total of eight patients were included in this study. The median age was 20 years (SD =14). There were four females and four males. There was a trend towards decreased LEC, saturation, and magnet swipes one year after March 2020 compared to before. However, the mean LEC (-2.47; 95% CI [-7.18, 2.24], p = 0.25), saturation (-0.11; 95% CI [-0.59, 0.38], p = 0.80), and magnet swipes (-0.12; 95% CI [-0.39, 0.15], p = 0.20) were not significantly different pre-COVID-19 period compared to one year into the COVID-19 period. There was also no significant difference in self-reported seizure frequency during this time-period. There was a significant reduction to in-person clinic visits (*p=0.021) after March 2020 and a trend towards increased telemedicine visits (p=0.100).
Conclusions: This study, using additional proxy measures of seizure frequency (RNS biomarkers) over a longer duration of time, increased our understanding of the impact of the COVID-19 pandemic on the care of patients with epilepsy. Our results confirm and extend prior research that suggested that RNS activity was not negatively impacted during the early part of the pandemic.
Funding: Investigator-initiated funding. No external funding source.
Clinical Epilepsy