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2. Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy

Author

Nair, Dileep R, Laxer, Kenneth D, Weber, Peter B, Murro, Anthony M, Park, Yong D, Barkley, Gregory L, Smith, Brien J, Gwinn, Ryder P, Doherty, Michael J, Noe, Katherine H, Zimmerman, Richard S, Bergey, Gregory K, Anderson, William S, Heck, Christianne, Liu, Charles Y, Lee, Ricky W, Sadler, Toni, Duckrow, Robert B, Hirsch, Lawrence J, Wharen, Robert E, Jr, Tatum, William, Srinivasan, Shraddha, McKhann, Guy M, Agostini, Mark A, Alexopoulos, Andreas V, Jobst, Barbara C, Roberts, David W, Salanova, Vicenta, Witt, Thomas C, Cash, Sydney S, Cole, Andrew J, Worrell, Gregory A, Lundstrom, Brian N, Edwards, Jonathan C, Halford, Jonathan J, Spencer, David C, Ernst, Lia, Skidmore, Christopher T, Sperling, Michael R, Miller, Ian, Geller, Eric B, Berg, Michel J, Fessler, A James, Rutecki, Paul, Goldman, Alica M, Mizrahi, Eli M, Gross, Robert E, Shields, Donald C, Schwartz, Theodore H, Labar, Douglas R, Fountain, Nathan B, Elias, W Jeff, Olejniczak, Piotr W, Villemarette-Pittman, Nicole R, Eisenschenk, Stephan, Roper, Steven N, Boggs, Jane G, Courtney, Tracy A, Sun, Felice T, Seale, Cairn G, Miller, Kathy L, Skarpaas, Tara L, and Morrell, Martha J

Published
2020
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15. Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography

Author

King-Stephens, David, Mirro, Emily, Weber, Peter B., Laxer, Kenneth D., Van Ness, Paul C., Salanova, Vicenta, Spencer, David C., Heck, Christianne N., Goldman, Alica, Jobst, Barbara, 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 R., Gwinn, Ryder P., Park, Yong D., Rutecki, Paul A., Fountain, Nathan B., Wharen, Robert E., Hirsch, Lawrence J., Miller, Ian O., Barkley, Gregory L., Edwards, Jonathan C., Geller, Eric B., Berg, Michel J., Sadler, Toni L., Sun, Felice T., and Morrell, Martha J.

Published
2015
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19. Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: Final results of the RNS System Pivotal trial

Author

Heck, Christianne N., King-Stephens, David, Massey, Andrew D., Nair, Dileep R., Jobst, Barbara C., Barkley, Gregory L., Salanova, Vicenta, Cole, Andrew J., Smith, Michael C., Gwinn, Ryder P., Skidmore, Christopher, Van Ness, Paul C., Bergey, Gregory K., Park, Yong D., Miller, Ian, Geller, Eric, Rutecki, Paul A., Zimmerman, Richard, Spencer, David C., Goldman, Alica, Edwards, Jonathan C., Leiphart, James W., Wharen, Robert E., Fessler, James, Fountain, Nathan B., Worrell, Gregory A., Gross, Robert E., Eisenschenk, Stephan, Duckrow, Robert B., Hirsch, Lawrence J., Bazil, Carl, OʼDonovan, Cormac A., Sun, Felice T., Courtney, Tracy A., Seale, Cairn G., and Morrell, Martha J.

Published
2014
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24. Interictal EEG and ECG for SUDEP Risk Assessment: A Retrospective Multicenter Cohort Study.

Author

Chen, Zhe Sage, Hsieh, Aaron, Sun, Guanghao, Bergey, Gregory K., Berkovic, Samuel F., Perucca, Piero, D'Souza, Wendyl, Elder, Christopher J., Farooque, Pue, Johnson, Emily L., Barnard, Sarah, Nightscales, Russell, Kwan, Patrick, Moseley, Brian, O'Brien, Terence J., Sivathamboo, Shobi, Laze, Juliana, Friedman, Daniel, and Devinsky, Orrin

Subjects
EPILEPSY, PARTIAL epilepsy, ELECTROENCEPHALOGRAPHY, HEART beat, CONVOLUTIONAL neural networks, RECEIVER operating characteristic curves, ELECTROCARDIOGRAPHY
Abstract

Objective: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality. Although lots of effort has been made in identifying clinical risk factors for SUDEP in the literature, there are few validated methods to predict individual SUDEP risk. Prolonged postictal EEG suppression (PGES) is a potential SUDEP biomarker, but its occurrence is infrequent and requires epilepsy monitoring unit admission. We use machine learning methods to examine SUDEP risk using interictal EEG and ECG recordings from SUDEP cases and matched living epilepsy controls. Methods: This multicenter, retrospective, cohort study examined interictal EEG and ECG recordings from 30 SUDEP cases and 58 age-matched living epilepsy patient controls. We trained machine learning models with interictal EEG and ECG features to predict the retrospective SUDEP risk for each patient. We assessed cross-validated classification accuracy and the area under the receiver operating characteristic (AUC) curve. Results: The logistic regression (LR) classifier produced the overall best performance, outperforming the support vector machine (SVM), random forest (RF), and convolutional neural network (CNN). Among the 30 patients with SUDEP [14 females; mean age (SD), 31 (8.47) years] and 58 living epilepsy controls [26 females (43%); mean age (SD) 31 (8.5) years], the LR model achieved the median AUC of 0.77 [interquartile range (IQR), 0.73–0.80] in five-fold cross-validation using interictal alpha and low gamma power ratio of the EEG and heart rate variability (HRV) features extracted from the ECG. The LR model achieved the mean AUC of 0.79 in leave-one-center-out prediction. Conclusions: Our results support that machine learning-driven models may quantify SUDEP risk for epilepsy patients, future refinements in our model may help predict individualized SUDEP risk and help clinicians correlate predictive scores with the clinical data. Low-cost and noninvasive interictal biomarkers of SUDEP risk may help clinicians to identify high-risk patients and initiate preventive strategies. [ABSTRACT FROM AUTHOR]

Published
2022
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42. Nonepileptic Posttraumatic Seizures

Author

Barry, Elizabeth, Krumholz, Allan, Bergey, Gregory K., Chatha, Herlene, Alemayehu, Shimellis, and Grattan, Lynn

Published
1998

46. Advances in antiepileptic drug treatments: a rational basis for selecting drugs for older patients with epilepsy

Author

Leppik, Ilo E., Bergey, Gregory K., Ramsay, R. Eugene, Rowan, A.J., Gidal, Barry E., Birnbaum, Angela K., and Elliott, Mary Beth

Subjects
Epilepsy -- Drug therapy, Aged -- Health aspects, Anticonvulsants, Health, Seniors
Abstract

Incidence of epilepsy increases rapidly after age 65; recent studies indicate that approximately 10% of nursing home residents are being treated with antiepileptic drugs (AEDs). Almost all are being treated with first generation AEDs. The average nursing home patient receives six medications, has age-related changes in protein binding, decreases in hepatic and renal clearance, and may have alterations in gastrointestinal absorption. AEDs that do not have drug-drug interactions, are not metabolized by the liver, and are readily absorbed may offer benefits in this population. New studies are demonstrating that the first generation AEDs have a number of shortcomings for treating older patients, whereas some of the newer AEDs may overcome these limitations. This paper reviews the present knowledge base and compares properties of the first generation AEDs with newer agents to develop a more rational approach for drug selection in older adults. Key words: antiepileptic drugs (AEDs) * epilepsy * seizures elderly * geriatrics, Use of antiepileptic drugs (AEDs) is common in older patients, especially those in nursing homes (NH). Recent studies have reported that approximately 10% of NH residents in the United States [...]

Published
2004

47. Controversies in epilepsy: debates held during the Fourth International Workshop on Seizure Prediction

Author

Frei, Mark G MG, Zaveri, Hitten P HP, Arthurs, Susan S, Bergey, Gregory K GK, Jouny, Christophe C CC, Lehnertz, Klaus K, Gotman, Jean J, Osorio, Ivan I, Netoff, Theoden I TI, Freeman, Walter III, Jefferys, John J, Worrell, Gregory G, Quyen, Michel Le Van Mle V, Schiff, Steven J SJ, and Mormann, Florian F

Subjects
Engineering, Medicine and Health Sciences, Physical Sciences and Mathematics
Abstract

Debates on six controversial topics were held during the Fourth International Workshop on Seizure Prediction (IWSP4) convened in Kansas City, KS, USA, July 4-7, 2009. The topics were (1) Ictogenesis: Focus versus Network? (2) Spikes and Seizures: Step-relatives or Siblings? (3) Ictogenesis: A Result of Hyposynchrony? (4) Can Focal Seizures Be Caused by Excessive Inhibition? (5) Do High-Frequency Oscillations Provide Relevant Independent Information? (6) Phase Synchronization: Is It Worthwhile as Measured? This article, written by the IWSP4 organizing committee and the debaters, summarizes the arguments presented during the debates.

Published
2010

48. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy.

Author

Geller, Eric B., Skarpaas, Tara L., Gross, Robert E., Goodman, Robert R., Barkley, Gregory L., Bazil, Carl W., Berg, Michael J., Bergey, Gregory K., Cash, Sydney S., Cole, Andrew J., Duckrow, Robert B., Edwards, Jonathan C., Eisenschenk, Stephan, Fessler, James, Fountain, Nathan B., Goldman, Alicia M., Gwinn, Ryder P., Heck, Christianne, Herekar, Aamar, and Hirsch, Lawrence J.

Subjects
BRAIN stimulation, TREATMENT of epilepsy, SEIZURES (Medicine), PARTIAL epilepsy, HIPPOCAMPUS (Brain)
Abstract

Objective Evaluate the seizure-reduction response and safety of mesial temporal lobe ( MTL) brain-responsive stimulation in adults with medically intractable partial-onset seizures of mesial temporal lobe origin. Methods Subjects with mesial temporal lobe epilepsy ( MTLE) were identified from prospective clinical trials of a brain-responsive neurostimulator ( RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. Results There were 111 subjects with MTLE; 72% of subjects had bilateral MTL onsets and 28% had unilateral onsets. Subjects had one to four leads placed; only two leads could be connected to the device. Seventy-six subjects had depth leads only, 29 had both depth and strip leads, and 6 had only strip leads. The mean follow-up was 6.1 ± (standard deviation) 2.2 years. The median percent seizure reduction was 70% (last observation carried forward). Twenty-nine percent of subjects experienced at least one seizure-free period of 6 months or longer, and 15% experienced at least one seizure-free period of 1 year or longer. There was no difference in seizure reduction in subjects with and without mesial temporal sclerosis ( MTS), bilateral MTL onsets, prior resection, prior intracranial monitoring, and prior vagus nerve stimulation. In addition, seizure reduction was not dependent on the location of depth leads relative to the hippocampus. The most frequent serious device-related adverse event was soft tissue implant-site infection (overall rate, including events categorized as device-related, uncertain, or not device-related: 0.03 per implant year, which is not greater than with other neurostimulation devices). Significance Brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior MTL resection. [ABSTRACT FROM AUTHOR]

Published
2017
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49. Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas.

Author

Jobst, Barbara C., Kapur, Ritu, Barkley, Gregory L., Bazil, Carl W., Berg, Michel J., Bergey, Gregory K., Boggs, Jane G., Cash, Sydney S., Cole, Andrew J., Duchowny, Michael S., Duckrow, Robert B., Edwards, Jonathan C., Eisenschenk, Stephan, Fessler, A. James, Fountain, Nathan B., Geller, Eric B., Goldman, Alica M., Goodman, Robert R., Gross, Robert E., and Gwinn, Ryder P.

Subjects
PARTIAL epilepsy, BRAIN stimulation, CLOSED loop systems, SPASMS, MAGNETIC resonance imaging
Abstract

Objective Evaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with medically intractable partial-onset seizures of neocortical origin. Methods Patients with partial seizures of neocortical origin were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. Additional analyses considered safety and seizure reduction according to lobe and functional area (e.g., eloquent cortex) of seizure onset. Results There were 126 patients with seizures of neocortical onset. The average follow-up was 6.1 implant years. The median percent seizure reduction was 70% in patients with frontal and parietal seizure onsets, 58% in those with temporal neocortical onsets, and 51% in those with multilobar onsets (last observation carried forward [LOCF] analysis). Twenty-six percent of patients experienced at least one seizure-free period of 6 months or longer and 14% experienced at least one seizure-free period of 1 year or longer. Patients with lesions on magnetic resonance imaging (MRI; 77% reduction, LOCF) and those with normal MRI findings (45% reduction, LOCF) benefitted, although the treatment response was more robust in patients with an MRI lesion (p = 0.02, generalized estimating equation [GEE]). There were no differences in the seizure reduction in patients with and without prior epilepsy surgery or vagus nerve stimulation. Stimulation parameters used for treatment did not cause acute or chronic neurologic deficits, even in eloquent cortical areas. The rates of infection (0.017 per patient implant year) and perioperative hemorrhage (0.8%) were not greater than with other neurostimulation devices. Significance Brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including adults with seizures of neocortical onset, and those with onsets from eloquent cortex. [ABSTRACT FROM AUTHOR]

Published
2017
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