Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography

King-Stephens, David; Mirro, Emily A.; Weber, Peter B.; Laxer, Kenneth D.; Ness, Paul C. Van; Salanova, Vicenta; Spencer, David C.; Heck, Christianne; Goldman, Alica M.; Jobst, Barbara C.; Shields, Donald C.; Bergey, Gregory K.; Eisenschenk, Stephan; Worrell, Gregory A.; Rossi, Marvin A.; Gross, Robert E.; Cole, Andrew J.; Sperling, Michael R.; Nair, Dileep; Gwinn, Ryder P.; Park, Yong D.; Rutecki, Paul; Fountain, Nathan B.; Wharen, Robert E.; Hirsch, Lawrence J.; Miller, Ian; Barkley, Gregory L.; Edwards, Jonathan; Geller, Eric B.; Berg, Michel J.; Sadler, Toni; Sun, Felice T.; Morrell, Martha J.

doi:10.1111/epi.13010

Cited by 187 publications

(128 citation statements)

References 20 publications

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“…With current technology, up to two regions can be simultaneously targeted for active therapy with RNS. Thus, RNS is typically pursued in patients with multiple EZs – such as bilateral mesial temporal seizure onset – or an EZ located in eloquent cortex not amenable to resection [78,16]. …”

Section: Neurostimulation Proceduresmentioning

confidence: 99%

Seizure outcomes in nonresective epilepsy surgery: an update

2016

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In approximately 30% of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several non-resective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly under-utilized. While non-resective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder - particularly individuals who are not candidates for or who have failed resection.

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Section: Neurostimulation Proceduresmentioning

confidence: 99%

Seizure outcomes in nonresective epilepsy surgery: an update

2016

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“…To date, there have been no reports of the use of NeuroPace to treat patients younger than 18 years of age; however, a number of features of NeuroPace may appeal for use in a pediatric population. One study explored the possibility of using the device as an outpatient chronic ambulatory electrocorticography (ECoG) device using the original trial data (64). Among 191 patients in the study cohort, 82 had received bilateral mesial temporal lobe implants with the NeuroPace device because clear lateralization was not present on preoperative evaluation.…”

Section: Responsive Neurostimulation (Rns)mentioning

confidence: 99%

Emerging surgical therapies in the treatment of pediatric epilepsy

Karsy¹,

Guan²,

Ducis³

et al. 2016

Transl. Pediatr.

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Abstract:In the approximately 1% of children affected by epilepsy, pharmacoresistance and early age of seizure onset are strongly correlated with poor cognitive outcomes, depression, anxiety, developmental delay, and impaired activities of daily living. These children often require multiple surgical procedures, including invasive diagnostic procedures with intracranial electrodes to identify the seizure-onset zone. The recent development of minimally invasive surgical techniques, including stereotactic electroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT), and new applications of neurostimulation, such as responsive neurostimulation (RNS), are quickly changing the landscape of the surgical management of pediatric epilepsy. In this review, the authors discuss these various technologies, their current applications, and limitations in the treatment of pediatric drug-resistant epilepsy, as well as areas for future research. The development of minimally invasive diagnostic and ablative surgical techniques together with new paradigms in neurostimulation hold vast potential to improve the efficacy and reduce the morbidity of the surgical management of children with drug-resistant epilepsy.

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“…The neurostimulator detects abnormal patterns of activity and responds by delivering brief, imperceptible pulses of electrical current to inhibit seizure activity. Although the RNS System is a clinical tool, the availability of chronic ECoG in ambulatory patients offers an unprecedented opportunity to study longitudinal patterns of brain activity (Anderson et al, 2015; DiLorenzo et al, 2014; King-Stephens et al, 2015; Smart et al, 2013; Spencer et al, 2016). However, the ability of the RNS System to record physiological responses from eloquent cortical regions has not been reported.…”

Section: Introductionmentioning

confidence: 99%

Chronic ambulatory electrocorticography from human speech cortex

et al. 2017

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Direct intracranial recording of human brain activity is an important approach for deciphering neural mechanisms of cognition. Such recordings, usually made in patients with epilepsy undergoing inpatient monitoring for seizure localization, are limited in duration and depend on patients’ tolerance for the challenges associated with recovering from brain surgery. Thus, typical intracranial recordings, similar to most non-invasive approaches in humans, provide snapshots of brain activity in acute, highly constrained settings, limiting opportunities to understand long timescale and natural, real-world phenomena. A new device for treating some forms of drug-resistant epilepsy, the NeuroPace RNS® System, includes a cranially-implanted neurostimulator and intracranial electrodes that continuously monitor brain activity and respond to incipient seizures with electrical counterstimulation. The RNS System can record epileptic brain activity over years, but whether it can record meaningful, behavior-related physiological responses has not been demonstrated. Here, in a human subject with electrodes implanted over high-level speech-auditory cortex (Wernicke’s area; posterior superior temporal gyrus), we report that cortical evoked responses to spoken sentences are robust, selective to phonetic features, and stable over nearly 1.5 years. In a second subject with RNS System electrodes implanted over frontal cortex (Broca’s area, posterior inferior frontal gyrus), we found that word production during a naming task reliably evokes cortical responses preceding speech onset. The spatiotemporal resolution, high signal-to-noise, and wireless nature of this system’s intracranial recordings make it a powerful new approach to investigate the neural correlates of human cognition over long timescales in natural ambulatory settings.

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Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography

Cited by 187 publications

References 20 publications

Seizure outcomes in nonresective epilepsy surgery: an update

Seizure outcomes in nonresective epilepsy surgery: an update

Emerging surgical therapies in the treatment of pediatric epilepsy

Chronic ambulatory electrocorticography from human speech cortex

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