Combined Surgical Resection and Responsive Neurostimulation for Drug-Resistant Epilepsy: A Case Series

Area of Science:

• Neurosurgery
• Epileptology
• Neuromodulation

Background:

• Drug-resistant epilepsy (DRE) poses challenges when the seizure onset zone involves eloquent cortex, limiting complete surgical resection.
• Responsive neurostimulation (RNS) is an option for DRE but rarely achieves complete seizure freedom.
• A hybrid approach combining subtotal resection with RNS may improve seizure control in select DRE patients.

Purpose of the Study:

• To investigate the efficacy of a hybrid approach combining partial resection with responsive neurostimulation (R + RNS) in patients with DRE.
• To determine if neuromodulation of unresected seizure onset zones enhances seizure control beyond subtotal resection alone.

Main Methods:

• Retrospective analysis of DRE patients who underwent R + RNS between 2020 and 2022.
• Assessment of seizure frequency reduction, seizure freedom duration, seizure severity, and subjective patient improvements.
• Minimum follow-up of 6 months post-intervention.

Main Results:

• Seven patients with DRE underwent R + RNS, with a mean follow-up of 20.7 months.
• A mean seizure frequency reduction of 79.3% was observed.
• Three patients (42.9%) achieved sustained seizure freedom with RNS, and one additional patient showed significant improvement after RNS optimization. Patients reported reduced seizure severity and improved sleep.

Conclusions:

• The R + RNS approach demonstrated substantial seizure reduction in DRE patients.
• This hybrid strategy is a potentially beneficial treatment for DRE patients unsuitable for complete resection due to eloquent cortex or multifocal involvement.
• R + RNS offers a viable option to improve seizure control and quality of life in challenging DRE cases.