Subthalamic nucleus stimulation in patients with intractable epilepsy: the Cleveland experience

Neme, Silvia; Montgomery, Erwin B.; Rezai, Ali R.; Wilson, Kathy; Lüders, Hans

doi:10.1201/9781003076421-33

Cited by 4 publications

(6 citation statements)

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“…Subsequently, STN stimulation was reported to be a promising chioce for patients with drug-resistant epilepsy who would not benefit from conventional surgery, accompanied by 42%-75% reduction in seizure frequency. 5,10,[21][22][23] In all patients in our study, seizure frequency decreased by an average of 64.0% after STN-DBS at last year follow-up, and one patient was seizure-free.…”

Section: Discussionmentioning

confidence: 65%

“…Fewer than 20 refractory epilepsy patients were treated with STN-DBS, and the efficacy rate ranges from 0% to 84%. 10,[20][21][22][23][24] Few clinical instances of STN-DBS for DRE have been reported; therefore, its effectiveness, ideal anatomical location, appropriate stimulation parameters, and selection criteria of patients are undefined. Here, we report six patients with DRE who underwent STN-DBS at the Chinese People's Liberation Army (PLA) General Hospital from June 2016 to December 2018 to investigate the safety and efficacy of STN-DBS for treating DRE.…”

Section: Introductionmentioning

confidence: 99%

“…There have been few cases of the clinical application of STN‐DBS. Fewer than 20 refractory epilepsy patients were treated with STN‐DBS, and the efficacy rate ranges from 0% to 84% 10,20–24 . Few clinical instances of STN‐DBS for DRE have been reported; therefore, its effectiveness, ideal anatomical location, appropriate stimulation parameters, and selection criteria of patients are undefined.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term efficacy of deep brain stimulation of the subthalamic nucleus in patients with pharmacologically intractable epilepsy: A case series of six patients

Cui

Wang

Mao

et al. 2023

Epileptic Disorders

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ObjectiveEpilepsy is one of the widespread neurological illnesses, and about 20%–40% of epilepsy patients are pharmacoresistant. We aimed to assess the long‐term efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) for drug‐resistant epilepsy.MethodsWe included pharmacologically intractable epilepsy patients who had STN‐DBS at the Chinese People's Liberation Army General Hospital between June 2016 and December 2018. We retrospectively evaluated pre‐ and postoperative clinical outcomes, including seizure frequency, seizure type, anti‐seizure medication, cognitive function, anatomical target coordinates, stimulation parameters, and adverse events following the surgical procedure. Six patients with a mean follow‐up of 49.3 ± 10.2 months, were included.ResultsSeizure frequency decreased by an average of 64.0% after STN‐DBS at last year follow‐up (p = .046), and one patient (1/6) achieved seizure‐free status. For seizure type, anti‐seizure medication, and cognitive function, there were no significant differences between pre‐and post‐operation (p > .05). In terms of stimulation parameters, the pulse width, amplitude, and frequency were 58.3 ± 9.4 μs, 2.5 ± .7 V, and 122.5 ± 15.7 Hz, respectively. None of the patients showed normal electroencephalography during the electroencephalography reexamination. There were no surgery‐related complications, and chronic STN stimulation was generally well tolerated in five patients. However, one patient (1/6) had a difficulty of dyskinesia in the right arm.SignificanceIn conclusion, neuromodulation of the STN by DBS is a promising option for patients with pharmacologically intractable epilepsy, especially for whose epileptic zone originates mainly from the frontoparietal region and who are unsuitable for resective surgery. Further prospective multicenter studies with a larger sample size are necessary for further exploration.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long‐term efficacy of deep brain stimulation of the subthalamic nucleus in patients with pharmacologically intractable epilepsy: A case series of six patients

Cui

Wang

Mao

et al. 2023

Epileptic Disorders

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“…Later on, Brown-Sequard, Jackson and Gowers independently, suggested that counter-irritation could be a mechanism for abating seizure activity [2,12,16,29]. Employment of uncontrolled open-loop, non-contingent stimulation has been attempted in several experimental studies and human trials for the control of epilepsy; stimulation of cerebellar cortex [4,5], cerebellar dentate nucleus [3,32], cerebral cortex [18,20] anterior thalamic nucleus [6,15,17], centromedian thalamic nucleus [3,32,[34][35][36], head of caudate nucleus [3,31,32], hippocampus [31,32,37] and subthalamic nucleus [1,27] has been employed with various clinical results. The only controlled clinical studies involved cerebellar cortex [33] and thalamic centromedian nucleus stimulation [8], and neither showed a significant effect on seizures.…”

Section: Introductionmentioning

confidence: 99%

“…The concept of closed-loop stimulation had been previously described, but to date, no controlled studies of its efficacy on seizure reduction had been reported [26][27][28]. The promising results of these initial pilot studies were confirmed by the results of a multi-center prospective clinical study, in which an external RNS was used [24,25].…”

Section: Introductionmentioning

confidence: 99%

A novel closed-loop stimulation system in the control of focal, medically refractory epilepsy

Fountas¹,

Smith²

Acta Neurochirurgica Supplements

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The concept of seizure abortion after prompt detection by employing stimulation is a very appealing one. Several investigators in previous experimental and clinical studies have used stimulation of various anatomical targets with promising results. In this chapter, the authors present their experience with a novel, implantable, local closed-loop responsive neuro-stimulation system (RNS) (Neuropace, Inc., Mountain View, CA, USA). This system consists of a cranially implanted pulse generator, one or two quadripolar subdural strip or depth leads and an external programmer. The system components and technical characteristics are presented. The criteria for selecting candidates for implantation as well as the preliminary results of a clinical trial are also presented. Closed-loop stimulation system appears to be a safe treatment option with promising results for the management of patients with welllocalized, focal medically-refractory epilepsy, who are not candidates for surgical resection.

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Implantation of a Closed-Loop Stimulation in the Management of Medically Refractory Focal Epilepsy

Fountas

Smith

Murro³

et al. 2005

Stereotact Funct Neurosurg

130

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Open-loop stimulation studies have shown varying control of seizures with stimulation of different anatomical targets. A recent multi-institutional clinical study utilizing an external closed-loop stimulation system had promising results. A novel implantable closed-loop Responsive Neurostimulation System (RNS) (Neuropace, Inc., Mountainview, Calif., USA) consisting of a cranially implanted pulse generator, one or two quadripolar subdural strip or depth leads and a programmer is under testing in a prospective clinical trial. The RNS pulse generator continuously analyzes the patient’s electrocortigrams (ECoGs) and automatically triggers electrical stimulation when specific ECoG characteristics programmed by the clinician, as indicative of electrographic seizures or precursor of epileptiform activities, are detected. The pulse generator then stores diagnostic information detailing detections and stimulations, including multichannel stored ECoGs. The RNS programmer communicates transcutaneously with the implanted pulse generator when initiated by a clinician. The RNS programmer can download diagnostics and store ECoGs for review. The RNS programmer can then be used to program detection and stimulation parameters. In our current communication, we describe the selection criteria for implanting this system, the preparation of the surgical candidates as well as the surgical technique. We also present our preliminary results with 8 patients who had an RNS implanted. Seven patients (87.5%) had more than 45% decrease in their seizure frequency. The mean follow-up time in our series was 9.2 months. The implantation of a closed-loop stimulation system, in our experience, represents a safe and relatively simple surgical procedure. However, the efficacy of this new treatment modality remains to be determined in further multi-institutional, prospective clinical studies.

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Subthalamic nucleus stimulation in patients with intractable epilepsy: the Cleveland experience

Cited by 4 publications

References 1 publication

Long‐term efficacy of deep brain stimulation of the subthalamic nucleus in patients with pharmacologically intractable epilepsy: A case series of six patients

Long‐term efficacy of deep brain stimulation of the subthalamic nucleus in patients with pharmacologically intractable epilepsy: A case series of six patients

A novel closed-loop stimulation system in the control of focal, medically refractory epilepsy

Implantation of a Closed-Loop Stimulation in the Management of Medically Refractory Focal Epilepsy

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