Responsive Neurostimulation Targeting the Motor Cortex for Treatment of Drug Resistant Epilepsy
Abstract number :
3.221
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2204524
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Brian Jung, MD – UCLA; Victoria Ho, MD, PhD – University of California Los Angeles Medical Center; Pue Farooque, DO – Yale; Tyler Gray, MS – Yale; Tiara Monroe Smith, BS, MEM – NeuroPace; Merit Vick, BS – NeuroPace Inc; Dawn Eliashiv, MD – University of California Los Angeles Medical Center
Rationale: Surgical options for treating patients with drug resistant epilepsy (DRE) involving the motor cortex are limited due to the likelihood of post-surgical deficits.1 Responsive neurostimulation (RNS® System) has been shown to be an effective and safe approach in these cases.2 We examined safety and efficacy of RNS System treatment targeting the motor cortex in patients with focal DRE.
Methods: We performed a retrospective chart review study at two centers of adult patients with focal DRE who had an RNS System between 2015 and 2022 with at least one cortical strip or depth lead placed in/on motor cortex.
Results: Eighteen patients were included (9 men/9 women). Demographics can be found in Table 1. Thirteen patients went from Phase II evaluation direct to RNS System implant and five patients had concurrent resection at the time of RNS system implant. The most common leads used were cortical strip leads: 14 patients received 2 cortical strip leads, 2 patients received 1 cortical strip and 1 depth lead, and 2 patients received 2 depth leads. Seventeen patients had stimulation enabled. One patient had a concurrent resection and has not had any electrographic seizures; therefore, stimulation was not enabled. Stimulation was started at low charge density with increases made over time as needed. Stimulation settings are summarized in Table 1. The mean maximum charge density was 2.15 μC/cm2 (range, 0.5-3.5 μC/cm2). The most common stimulation pathway was lead-to-lead, but cathodal monopolar and bipolar stimulation pathways were also programmed based on lead type and lead proximity to one another. Median seizure reduction for the entire group was 75% with an average follow up time of 32.3 months (range, 4-63). The median percent reduction for 13 patients who did not have concurrent resection was also 75%. None of the patients had complications from surgical placement of the RNS or adverse side effects from the neurostimulation therapy.
Conclusions: In our small cohort of patients with focal, drug resistant epilepsy, responsive neurostimulation of the primary motor cortex was safe, effective, and well-tolerated. For patients with concurrent resection at the time of RNS System implant, it is not known how much the seizure reduction was related to the resection surgery, but this favorable outcome suggests that a combined RNS and surgery treatment can be effective and safe. The next steps include a larger multi-center retrospective review.
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References:
1. Kim YH, et al. Risk factor analysis of the development of new neurological deficits following supplementary motor area resection. J Neurosurg. 2013;119(1):7-14. doi: 10.3171/2013.3.JNS121492_x000D_
2. Jobst BC, et al. Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas. Epilepsia. 2017;58(6):1005-1014. doi: 10.1111/epi.13739
Funding: Not applicable
Clinical Epilepsy