Single-center Experience of DBS for Drug-resistant Epilepsy
Abstract number :
2.158
Submission category :
3. Neurophysiology / 3E. Brain Stimulation
Year :
2024
Submission ID :
678
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Kristen Zemina, MD – University of South Florida
Musab Al-Yahia, MD – University of South Florida
Ushtar Amin, MD – University of South Florida Morsani College of Medicine
Marina Azevedo, BSc – University of South Florida
Yarema Bezchlibnyk, MD PhD – University of South Florida
Holly Chandler, PA – University of South Florida
Ana Omura, Bsc – University of South Florida
Angelica Rivera-Cruz, MD – University of South Florida
Selim Benbadis, MD – University of South Florida
Rationale: Deep-brain stimulation (DBS) is the most recently FDA-approved neurostimulation modality for drug-resistant epilepsy. We aim to describe our experience with DBS.
Methods: Retrospective analysis of patients implanted with DBS from 5/2019 to 3/2024 followed at our center.
Patients were categorized into subgroups by epilepsy diagnoses (mesiotemporal, extratemporal/neocortical, and generalized), history of surgical intervention (VNS, RNS or resection), and duration of epilepsy prior to DBS placement (divided into 10 year increments).
Outcomes were assessed by patient-reported seizure frequency during clinic visits with a scale denoting worsening seizure frequency, stability, or improvement (divided into 25% increments).
Surgical complications were also reviewed, defined as a return to the operating room.
Results: Twenty seven patients were analyzed. Of the 27, 25 patients had focal epilepsy (6 with mesiotemporal and 19 extratemporal or neocortical) and 2 carried a diagnosis of idiopathic generalized epilepsy. Eighteen patients had undergone resection or had another device (8 had VNS alone, 4 with resection only and 6 with a combination of VNS, resection or RNS). 4 of the VNS and 2 of the RNS devices were turned off or explanted due to ineffectiveness or complications. Three patients had surgical complications, only 1 of which required device removal.
Outcomes between mesiotemporal epilepsy and neocortical/extratemporal epilepsy were equivocal (including those with multifocal onset). Both patients with generalized epilepsy reported worsening of their seizure frequency post DBS placement.
Patients who had undergone resection or had other devices prior to DBS implantation had worse outcomes than patients with DBS alone.
Patients who carried a diagnosis of epilepsy for less than 10 years or greater than 30 years had better outcomes than those who were diagnosed between 10 and 29 years prior to DBS placement.
Conclusions: Among patients with focal epilepsy, there was not significant difference between mesiotemporal and extratemporal/neocortical epilepsy. Notably, both patients with generalized epilepsy reported worsening of their seizure frequency post DBS placement.
Also interesting was that patients with a prolonged duration of diagnosis prior to DBS placement (30+ years) and those with the shortest duration of diagnosis (< 10 years) had better outcomes than those with a diagnosis for 10-29 years.
Predictably, patients with a concomitant device, such as VNS or RNS, or those who had previously undergone resection, had worse outcomes compared to patients with DBS alone. This finding likely suggests that the former subgroup are more intractable at baseline and therefore less responsive to interventions than those who have DBS alone.
Overall, our findings reflect the data presented in the SANTE trial with a 50% responder rate of 44.44% at 1 year. Surgical complications were also rare, with only one patient requiring explantation.
Larger studies with longer follow up are warranted to assess whether the other trends present in our patient cohort can be extrapolated to the general population. Understanding these trends will help identify patients who would most benefit from DBS placement
Funding: NA
Neurophysiology