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

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

Authors :
Geller EB
Skarpaas TL
Gross RE
Goodman RR
Barkley GL
Bazil CW
Berg MJ
Bergey GK
Cash SS
Cole AJ
Duckrow RB
Edwards JC
Eisenschenk S
Fessler J
Fountain NB
Goldman AM
Gwinn RP
Heck C
Herekar A
Hirsch LJ
Jobst BC
King-Stephens D
Labar DR
Leiphart JW
Marsh WR
Meador KJ
Mizrahi EM
Murro AM
Nair DR
Noe KH
Park YD
Rutecki PA
Salanova V
Sheth RD
Shields DC
Skidmore C
Smith MC
Spencer DC
Srinivasan S
Tatum W
Van Ness PC
Vossler DG
Wharen RE Jr
Worrell GA
Yoshor D
Zimmerman RS
Cicora K
Sun FT
Morrell MJ
Source :
Epilepsia [Epilepsia] 2017 Jun; Vol. 58 (6), pp. 994-1004. Date of Electronic Publication: 2017 Apr 11.
Publication Year :
2017

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.<br />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.<br />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).<br />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.<br /> (© 2017 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.)

Details

Language :
English
ISSN :
1528-1167
Volume :
58
Issue :
6
Database :
MEDLINE
Journal :
Epilepsia
Publication Type :
Academic Journal
Accession number :
28398014
Full Text :
https://doi.org/10.1111/epi.13740