Utilization of Resting state fMRI in predicting Clinical Response to Responsive Neurostimulation in Medial Temporal Lobe Patients
Abstract number :
153
Submission category :
9. Surgery / 9A. Adult
Year :
2020
Submission ID :
2422501
Source :
www.aesnet.org
Presentation date :
12/5/2020 9:07:12 AM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Pue Farooque, Yale University Department of Neurology; Jagriti Arora - Yale University Department of Radiology and Biomedical Imaging; Imran Quraishi - Yale University School of Medicine; Lawrence Hirsch - Yale University School of Medicine; Dennis Spence
Rationale:
The responsive neurostimulation system (RNS,, NeuroPace, Inc.) was FDA approved in 2013 for the treatment of medically refractory epilepsy. In the multi-center randomized clinical trial the RNS system was shown to reduce seizure frequency as compared to sham stimulation; however not every patient responded to this treatment modality. There are few studies evaluating predictors of outcome with RNS stimulation and we aimed to evaluate the role of resting state fMRI in predicting clinical response to RNS in patients with medial temporal lobe epilepsy(mTLE).
Method:
We evaluated all patients with mTLE that were implanted with the RNS device and had at least one year outcome post-implantation at the Yale Comprehensive Epilepsy Center. Patients were grouped into responders defined as greater than 50% seizure reduction from baseline and non-responders with less than 50% seizure reduction. Whole brain resting state fMRI was evaluated for these groups and individually compared to age matched controls and to each other.
Results:
A total of 10 patient with mTLE implanted with RNS were identified from 2006-2019. Of those patients only 7 patients had resting state fMRI images available. Six patients had bilateral medial temporal onset seizures treated with bilateral RNS implants and one patient had a unilateral RNS implant for unilateral temporal seizures. Four patients were responders and three were non-responders. Resting state fMRI analysis revealed increased connectivity in the posterior cingulate for non-responders when compared to age matched controls and responders. In comparing resting state fMRI analysis between non-responders to responders decreased connectivity was seen in the anterior cingulate, medial frontal and orbitofrontal regions.
Conclusion:
Based on our small sample size it appears that resting state fMRI may have the ability to predict clinical response in medial temporal patients implanted with RNS. Patients who had less than 50% reduction in seizure frequency with stimulation by RNS were found to have decreased connectivity in the anterior cingulate and medial frontal regions in comparison to responders and increased connectivity in the posterior cingulate region when compared to age matched controls and responders. A larger multicenter trial will need to be conducted to validate these findings and to further understand their implication in the selection and treatment of patients with medial temporal lobe epilepsy with RNS.
Funding:
:None
Surgery