Responsive neurostimulation for focal motor status epilepticus

Yang, Jimmy C.; Harid, Nitish M; Nascimento, Fábio A.; Kokkinos, Vasileios; Shaughnessy, Abigail; Lam, Alice; Westover, M. Brandon; Leslie‐Mazwi, Thabele M; Hochberg, Leigh R.; Rosenthal, Eric S.; Cole, Andrew J.; Richardson, R. Mark; Cash, Sydney S.

doi:10.1002/acn3.51318

Cited by 12 publications

(4 citation statements)

References 36 publications

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“…Similar results were obtained from a review of eight patients implanted with DBS targeting the zona incerta, anterior thalamic nucleus or centromedian thalamic nucleus [64]. Other recent single case reports show efficacy for status epilepticus treatment, including 6 Hz DBS of the bilateral centromedian nucleus [43], RNS with two occipital strips [65] and TMS for occipital-onset seizures [47].…”

Section: Stimulation For Status Epilepticussupporting

confidence: 79%

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: Stimulation For Status Epilepticussupporting

confidence: 79%

Emerging approaches in neurostimulation for epilepsy

Lundstrom

Osman

Starnes

et al. 2023

Current Opinion in Neurology

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“…Of the 81 studies in the literature that met the inclusion criteria, 13–92 the majority (60) reported only one patient. The remaining studies characterized a variable number of patients, ranging from 2 to 20.…”

Section: Resultsmentioning

confidence: 99%

Surgical management of status epilepticus: A systematic review

Jha,

Blitz,

Chua

et al. 2024

Epilepsia Open

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Status Epilepticus (SE), unresponsive to medical management, is associated with high morbidity and mortality. Surgical management is typically considered in these refractory cases. The best surgical approach for affected patients remains unclear; however, given the lack of controlled trials exploring the role of surgery. We performed a systematic review according to PRIMSA guidelines, including case reports and series describing surgical interventions for patients in SE. Cases (157 patients, median age 12.9 years) were followed for a median of 12 months. Patients were in SE for a median of 21 days before undergoing procedures including: focal resection (36.9%), functional hemispherectomy (21%), lobar resection (12.7%), vagus nerve stimulation (VNS) (12.7%), deep brain stimulation (DBS) (6.4%), multiple subpial transection (MST) (3.8%), responsive neurostimulation (RNS) (1.9%), and cortical stimulator placement (1.27%), with 24 patients undergoing multiple procedures. Multiple SE semiologies were identified. 47.8% of patients had focal seizures, and 65% of patients had focal structural abnormalities on MRI. SE persisted for 36.8 ± 47.7 days prior to surgical intervention. SE terminated following surgery in 81.5%, terminated with additional adjuncts in 10.2%, continued in 1.9%, and was not specified in 6.4% of patients. Long‐term seizure outcomes were favorable, with the majority improved and 51% seizure‐free. Eight patients passed away in follow‐up, of which three were in SE. Seizures emerging from one hemisphere were both more likely to immediately terminate (OR 4.7) and lead to long‐term seizure‐free status (OR 3.9) compared to nonunilateral seizures. No other predictors, including seizure focality, SE duration, or choice of surgical procedure, were predictors of SE termination. Surgical treatment of SE can be effective in terminating SE and leading to sustained seizure freedom, with many different procedures showing efficacy if matched appropriately with SE semiology and etiology.Plain Language SummaryPatients with persistent seizures (Status Epilepticus) that do not stop following medications can be treated effectively with surgery. Here, we systematically review the entirety of existing literature on surgery for treating status epilepticus to better identify how and when surgery is used and what patients do after surgery.

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“…These are connected to a programmable device which is cranially implanted and can provide electrical stimulation in response to detected ictal electrocorticographic activity [46]. About 10 cases have been described and the results are positive [47][48][49][50], and likely more cases will be described soon, but the published peer-reviewed cases regard adults and thus further details were considered out of scope of this review for the paediatric population.…”

Section: Invasive Neuromodulation Techniquesmentioning

confidence: 99%

Neuromodulation Techniques in Children with Super-Refractory Status Epilepticus

Stavropoulos,

Pak,

Alarcon

et al. 2023

Brain Sciences

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Status epilepticus (SE) is a life-threatening condition and medical emergency which can have lifelong consequences, including neuronal death and alteration of neuronal networks, resulting in long-term neurologic and cognitive deficits in children. When standard pharmacological treatment for SE is not successful in controlling seizures, the condition evolves to refractory SE (rSE) and finally to super-refractory SE (srSE) if it exceeds 24 h despite using anaesthetics. In this systematic review, we present literature data on the potential uses of clinical neuromodulation techniques for the management of srSE in children, including electroconvulsive therapy, vagus nerve stimulation, and deep brain stimulation. The evaluation of these techniques is limited by the small number of published paediatric cases (n = 25, one with two techniques) in peer-reviewed articles (n = 18). Although neuromodulation strategies have not been tested through randomised, prospective controlled clinical trials, this review presents the existing data and the potential benefits of neuromodulation therapy, suggesting that these techniques, when available, could be considered at earlier stages within the course of srSE intending to prevent long-term neurologic complications. Clinical trials aiming to establish whether early intervention can prevent long-term sequelae are necessary in order to establish the potential clinical value of neuromodulation techniques for the treatment of srSE in children.

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Responsive neurostimulation for focal motor status epilepticus

Cited by 12 publications

References 36 publications

Emerging approaches in neurostimulation for epilepsy

Emerging approaches in neurostimulation for epilepsy

Surgical management of status epilepticus: A systematic review

Neuromodulation Techniques in Children with Super-Refractory Status Epilepticus

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