128-Channel deep brain recording probe with heterogenously integrated analog CMOS readout for focal epilepsy localization

Magnetoencephalography (MEG) is increasingly used for presurgical planning in people with medically refractory focal epilepsy. Localization of interictal epileptiform activity, a surrogate for the seizure onset zone whose removal may prevent seizures, is challenging and depends on the use of multiple complementary techniques. Accurate and reliable localization of epileptiform activity from spontaneous MEG data has been an elusive goal. One approach toward this goal is to use a novel Bayesian inference algorithm—the Champagne algorithm with noise learning—which has shown tremendous success in source reconstruction, especially for focal brain sources. In this study, we localized sources of manually identified MEG spikes using the Champagne algorithm in a cohort of 16 patients with medically refractory epilepsy collected in two consecutive series. To evaluate the reliability of this approach, we compared the performance to equivalent current dipole (ECD) modeling, a conventional source localization technique that is commonly used in clinical practice. Results suggest that Champagne may be a robust, automated, alternative to manual parametric dipole fitting methods for localization of interictal MEG spikes, in addition to its previously described clinical and research applications.

Download Full-text

Headache Perception in an Epilepsy Patient with Neuromodulation by Anterior Thalamic Nuclei Deep Brain Stimulation: A Case Report

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1685508 ◽

2020 ◽

Vol 81 (04) ◽

pp. 368-371

Author(s):

Bogdan Pintea ◽

Rainer Surges ◽

Jan Boström

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Chronic Headache ◽

Pain Perception ◽

Focal Epilepsy ◽

Thalamic Nuclei ◽

Pain Anxiety ◽

Anterior Thalamic Nuclei ◽

Pain Anxiety Symptoms Scale ◽

Deep Brain

Abstract Objective Headache disorders are frequently associated with epilepsy. Some neuromodulation techniques for refractory epilepsy have been reported to positively influence the associated chronic headache. However, the exact mechanism of action of vagus nerve stimulation (VNS) and anterior thalamic nuclei-deep brain stimulation (ANT-DBS) on pain perception is unclear. Method We report a structured assessment of pain perception in a patient who experienced headache relief after ANT-DBS for refractory focal epilepsy and compare it with pain perception of epilepsy patients with chronic headache who were treated with and without VNS. Results The pain-associated symptoms in the ANT-DBS case were on the Pain Anxiety Symptoms Scale (PASS-40) subscore “physiological anxiety” closer to the control collective, whereas in patients with VNS, this was more likely for the PASS-40 subscores “cognitive anxiety” or “escape and avoidance.” Conclusion ANT-DBS and VNS may influence epilepsy-associated chronic headache in different ways.

Download Full-text

Drug-resistant epilepsy, early-onset hypertension and white matter lesions: a hidden paraganglioma

BMJ Case Reports ◽

10.1136/bcr-2018-228348 ◽

2019 ◽

Vol 12 (6) ◽

pp. e228348

Author(s):

Katri Silvennoinen ◽

Alison J Waghorn ◽

Simona Balestrini ◽

Sanjay M Sisodiya

Keyword(s):

White Matter ◽

Seizure Control ◽

Focal Epilepsy ◽

White Matter Lesions ◽

Drug Resistant ◽

Deep Brain Stimulator ◽

Drug Resistant Epilepsy ◽

Hyperintense White Matter ◽

Deep Brain

We describe the case of a 35-year-old man with focal epilepsy since age 16. Due to a refractory course, several treatments were tried over the years, including insertion of a deep brain stimulator. At the time of his first assessment at our unit, he had recently been diagnosed with hypertension. An MR scan of brain revealed multiple T2 hyperintense white matter lesions, and evidence of previous haemorrhage in the left basal ganglia and pons. On follow-up imaging, the changes were considered to be in keeping with hypertensive arteriopathy. He was referred for further assessment of his hypertension and was found to have a para-aortic paraganglioma. This was excised 16 months after his initial presentation to us. The surgery was associated with an improvement in his seizure control. This case serves as a reminder of the need to be vigilant about the possibility of coexisting conditions in people with epilepsy.

Download Full-text

Neuromodulation for Refractory Epilepsy

Epilepsy Currents ◽

10.1177/15357597211065587 ◽

2021 ◽

pp. 153575972110655

Author(s):

Philippe Ryvlin ◽

Lara E. Jehi

Keyword(s):

Focal Epilepsy ◽

Refractory Status Epilepticus ◽

Seizure Freedom ◽

Treatment Pathways ◽

Refractory Status ◽

High Level ◽

Implanted Device ◽

Term Data ◽

Deep Brain

Three neuromodulation therapies, all using implanted device and electrodes, have been approved to treat adults with drug-resistant focal epilepsy, namely, the vagus nerve stimulation in 1995, deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) in 2018 (2010 in Europe), and responsive neurostimulation (RNS) in 2014. Indications for VNS have more recently extended to children down to age of 4. Limited or anecdotal data are available in other epilepsy syndromes and refractory/super-refractory status epilepticus. Overall, neuromodulation therapies are palliative, with only a minority of patients achieving long-term seizure freedom, justifying favoring such treatments in patients who are not good candidates for curative epilepsy surgery. About half of patients implanted with VNS, ANT-DBS, and RNS have 50% or greater reduction in seizures, with long-term data suggesting increased efficacy over time. Besides their impact on seizure frequency, neuromodulation therapies are associated with various benefits and drawbacks in comparison to antiseizure drugs. Yet, we lack high-level evidence to best position each neuromodulation therapy in the treatment pathways of persons with difficult-to-treat epilepsy.

Download Full-text