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Recurrent seizures related to motor cortex stimulator programming
Jaimie M Henderson1, Gary Heit, Robert S Fisher
1Stanford School of Medicine, Department of Neurosurgery, Stanford, CA, USA; The Permanente Medical Group, Department of Neurosurgery, Redwood City, CA, USA; and Stanford School of Medicine, Departments of Neurology and Neurosurgery, Stanford CA, USA.
Motor cortex stimulation (MCS) for pain may cause seizures during or after programming, particularly at 70-90 Hz. While a risk, no patients developed chronic epilepsy from this treatment.
Area of Science:
- Neurology
- Neurosurgery
- Pain Management
Background:
- Motor cortex stimulation (MCS) is an emerging therapy for intractable pain.
- Seizures are a known risk during MCS system programming.
- Seizures can occur hours after programming, impacting treatment efficacy.
Purpose of the Study:
- To investigate seizures as a limiting factor in MCS efficacy.
- To analyze the characteristics of seizures associated with MCS programming.
Main Methods:
- Retrospective chart review of five patients who underwent MCS between 2002 and 2006.
- Analysis of seizure occurrence, amplitude, frequency, and timing relative to programming.
- Assessment of MCS efficacy and system explantation.
Main Results:
- Seizures occurred during programming at amplitudes of 4.8–6.6 V and subsequently at 4.4–5.5 V.
- A trend towards decreasing seizure thresholds was observed.
- All patients experienced delayed seizures hours after programming; 4/5 patients had seizures linked to 70–90 Hz stimulation frequencies.
Conclusions:
- Seizures during and after MCS programming are a significant risk requiring anticipation.
- Stimulation frequencies between 70 and 90 Hz were associated with seizures in this cohort.
- MCS did not lead to chronic epilepsy in the studied patients.
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