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Responsive neurostimulation for regional neocortical epilepsy
Brandy B Ma1, Madeline C Fields2, Robert C Knowlton1
1Department of Neurology and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
Epilepsia
|December 13, 2019
Summary
Responsive neurostimulation (RNS) effectively reduces seizures in patients with drug-resistant focal epilepsy and regional seizure-onset zones. This treatment offers a viable option when surgery is not feasible, showing significant seizure frequency reduction.
Area of Science:
- Neurology
- Neurosurgery
- Epilepsy Research
Background:
- Drug-resistant focal epilepsy often necessitates alternative treatments when surgical resection is not an option.
- A regional seizure-onset zone (SOZ) can preclude traditional resective surgery.
- Responsive neurostimulation (RNS) is a potential therapeutic avenue for these patients.
Purpose of the Study:
- To evaluate the efficacy and feasibility of the RNS System in patients with drug-resistant focal epilepsy and a regional neocortical SOZ.
- To assess seizure frequency reduction and explore correlations between clinical outcomes and stimulation parameters.
Main Methods:
- A multicenter retrospective cohort study included 30 patients with drug-resistant focal epilepsy and a regional neocortical SOZ.
- Patients received RNS System treatment for at least 6 months, with leads placed over the SOZ.
- Seizure frequency was compared to pre-implant baseline, and outcomes were correlated with stimulation parameters.
Main Results:
- A median reduction of 75.5% in clinical seizure frequency was observed.
- No significant difference in outcome was found between patients with and without concurrent partial resection.
- Low charge densities were commonly used, but stimulation parameters did not significantly correlate with outcomes.
Conclusions:
- Responsive neurostimulation (RNS) is a feasible and effective treatment for drug-resistant focal epilepsy with regional neocortical seizures.
- Further prospective studies are needed to optimize lead placement and stimulation parameters.
- Lead-to-lead stimulation and low charge density may be effective in select patients.
