Invasive neuromodulation for epilepsy: Comparison of multiple approaches from a single center

Alcalá-Zermeño, Juan Luis; Gregg, Nicholas M.; Starnes, Keith; Mandrekar, Jayawant N.; Gompel, Jamie J. Van; Miller, Kai J.; Worrell, Greg; Lundstrom, Brian Nils

doi:10.1016/j.yebeh.2022.108951

Cited by 15 publications

(25 citation statements)

References 42 publications

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“…Strong objective evidence is often lacking to guide emerging neurostimulation applications. Retrospective comparisons have not found differences between VNS and RNS [8 ▪ ,9], DBS-ANT and RNS [10 ▪ ], and between RNS, DBS, VNS and cortical stimulation (with the possible increased efficacy of CSS in one single-centre comparison of this emerging neurostimulation method) [11 ▪ ]. Here, we focus on recent results and innovative aspects of neurostimulation, including targeted brain regions, uses of implanted hardware, stimulation programming and noninvasive approaches.…”

Section: Introductionmentioning

confidence: 99%

Emerging approaches in neurostimulation for epilepsy

Lundstrom

Osman

Starnes

et al. 2023

Current Opinion in Neurology

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Purpose of reviewNeurostimulation is a quickly growing treatment approach for epilepsy patients. We summarize recent approaches to provide a perspective on the future of neurostimulation.Recent findingsInvasive stimulation for treatment of focal epilepsy includes vagus nerve stimulation, responsive neurostimulation of the cortex and deep brain stimulation of the anterior nucleus of the thalamus. A wide range of other targets have been considered, including centromedian, central lateral and pulvinar thalamic nuclei; medial septum, nucleus accumbens, subthalamic nucleus, cerebellum, fornicodorsocommissure and piriform cortex. Stimulation for generalized onset seizures and mixed epilepsies as well as increased efforts focusing on paediatric populations have emerged. Hardware with more permanently implanted lead options and sensing capabilities is emerging. A wider variety of programming approaches than typically used may improve patient outcomes. Finally, noninvasive brain stimulation with its favourable risk profile offers the potential to treat increasingly diverse epilepsy patients.SummaryNeurostimulation for the treatment of epilepsy is surprisingly varied. Flexibility and reversibility of neurostimulation allows for rapid innovation. There remains a continued need for excitability biomarkers to guide treatment and innovation. Neurostimulation, a part of bioelectronic medicine, offers distinctive benefits as well as unique challenges.

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Section: Introductionmentioning

confidence: 99%

Emerging approaches in neurostimulation for epilepsy

Lundstrom

Osman

Starnes

et al. 2023

Current Opinion in Neurology

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“…17,18 Of note, a study at our institution found a MSR of 52% at 23 months for ANT-DBS, which is very close to the rate reported at 2 years by the SANTE trial. 19 The difference with the current research might be due to different selection criteria and methods. In particular, we focus on 31 patients who had undergone ANT-DBS using only the TPEV approach, and data collection was performed through a chart review instead of an outcome-focused survey.…”

Section: Discussionmentioning

confidence: 85%

Temporo-Parietal Extraventricular Approach for Deep Brain Stimulation Targeting the Anterior Nucleus of the Thalamus: Institutional Experience

et al. 2023

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BACKGROUND AND OBJECTIVES: The anterior nucleus of the thalamus (ANT) is a common target for deep brain stimulation (DBS) for drug-resistant epilepsy (DRE). However, the surgical approach to the ANT remains challenging because of its unique anatomy. This study aims to summarize our experience with the posterior temporo-parietal extraventricular (TPEV) approach targeting the ANT for DBS in DRE. METHODS: We performed a retrospective analysis of patients with DRE who underwent ANT-DBS using the TPEV approach between January 2011 and February 2021. Subjects with at least 6-month follow-up were eligible. The final lead position and number of active contacts targeting the anteroventral nucleus (AV) of the ANT were assessed using Lead-DBS. Mean seizure frequency reduction percentage and responder rate (≥50% decrease in seizure frequency) were determined. RESULTS: Thirty-one patients (mean age: 32.9 years; 52% female patients) were included. The mean follow-up period was 27.6 months ± 13.9 (29, 16-36). The mean seizure frequency reduction percentage was 65% ± 26 (75, 50-82). Twenty-six of 31 participants (83%) were responders, P < .001. Two subjects (6%) were seizure-free for at least 6 months at the last evaluation. Antiepileptic drugs dose and/or number decreased in 17/31 subjects (55%). The success rate for placing at least 1 contact at AV was 87% (27/31 patients) bilaterally. The number of active contacts at the AV was significantly greater in the responder group, 3.1 ± 1.3 (3, 2-4) vs 1.8 ± 1.1 (2, 1-2.5); P = .041 with a positive correlation between the number of active contacts and seizure reduction percentage; r = 0.445, R2 = 0.198, P = .012. CONCLUSION: The TPEV trajectory is a safe and effective approach to target the ANT for DBS. Future studies are needed to compare the clinical outcomes and target accuracy with the standard approaches.

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“…Invasive neuromodulation has become an effective tool to reduce seizure frequency, improve quality of life, 8 and reduce mortality in patients living with DRE. 9,10 In the strictest sense, all HEP2 participants were candidates for device implantation and were followed at National Association of Epilepsy Centers (NAEC) level 4 epilepsy centers capable of offering them, yet only one third of the patients had a neuromodulation device implanted.…”

Section: Discussionmentioning

confidence: 99%

Racial disparities in the utilization of invasive neuromodulation devices for the treatment of drug‐resistant focal epilepsy

Alcala‐Zermeno,

Fureman,

Grzeskowiak

et al. 2024

Epilepsia

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Racial disparities affect multiple dimensions of epilepsy care including epilepsy surgery. This study aims to further explore these disparities by determining the utilization of invasive neuromodulation devices according to race and ethnicity in a multicenter study of patients living with focal drug‐resistant epilepsy (DRE). We performed a post hoc analysis of the Human Epilepsy Project 2 (HEP2) data. HEP2 is a prospective study of patients living with focal DRE involving 10 sites distributed across the United States. There were no statistical differences in the racial distribution of the study population compared to the US population using census data except for patients reporting more than one race. Of 154 patients enrolled in HEP2, 55 (36%) underwent invasive neuromodulation for DRE management at some point in the course of their epilepsy. Of those, 36 (71%) were patients who identified as White. Patients were significantly less likely to have a device if they identified solely as Black/African American than if they did not (odds ratio = .21, 95% confidence interval = .05–.96, p = .03). Invasive neuromodulation for management of DRE is underutilized in the Black/African American population, indicating a new facet of racial disparities in epilepsy care.

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Invasive neuromodulation for epilepsy: Comparison of multiple approaches from a single center

Cited by 15 publications

References 42 publications

Emerging approaches in neurostimulation for epilepsy

Emerging approaches in neurostimulation for epilepsy

Temporo-Parietal Extraventricular Approach for Deep Brain Stimulation Targeting the Anterior Nucleus of the Thalamus: Institutional Experience

Racial disparities in the utilization of invasive neuromodulation devices for the treatment of drug‐resistant focal epilepsy

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