scholarly journals Chronic subthreshold cortical stimulation for adult drug-resistant focal epilepsy: safety, feasibility, and technique

2018 ◽  
Vol 129 (2) ◽  
pp. 533-543 ◽  
Author(s):  
Panagiotis Kerezoudis ◽  
Sanjeet S. Grewal ◽  
Matthew Stead ◽  
Brian Nils Lundstrom ◽  
Jeffrey W. Britton ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Cortical Stimulation ◽  
Adult Patients ◽  
Therapeutic Trial ◽  
Drug Resistant ◽  
Surgical Safety ◽  
Institutional Experience ◽  
Eloquent Cortex ◽  
Drug Resistant Epilepsy ◽  
Seizure Foci

OBJECTIVEEpilepsy surgery is effective for lesional epilepsy, but it can be associated with significant morbidity when seizures originate from eloquent cortex that is resected. Here, the objective was to describe chronic subthreshold cortical stimulation and evaluate its early surgical safety profile in adult patients with epilepsy originating from seizure foci in cortex that is not amenable to resection.METHODSAdult patients with focal drug-resistant epilepsy underwent intracranial electroencephalography monitoring for evaluation of resection. Those with seizure foci in eloquent cortex were not candidates for resection and were offered a short therapeutic trial of continuous subthreshold cortical stimulation via intracranial monitoring electrodes. After a successful trial, electrodes were explanted and permanent stimulation hardware was implanted.RESULTSTen patients (6 males) who underwent chronic subthreshold cortical stimulation between 2014 and 2016 were included. Based on radiographic imaging, intracranial pathologies included cortical dysplasia (n = 3), encephalomalacia (n = 3), cortical tubers (n = 1), Rasmussen encephalitis (n = 1), and linear migrational anomaly (n = 1). The duration of intracranial monitoring ranged from 3 to 20 days. All patients experienced an uneventful postoperative course and were discharged home with a median length of stay of 10 days. No postoperative surgical complications developed (median follow-up length 7.7 months). Seizure severity and seizure frequency improved in all patients.CONCLUSIONSThe authors’ institutional experience with this small group shows that chronic subthreshold cortical stimulation can be safely and effectively performed in appropriately selected patients without postoperative complications. Future investigation will provide further insight to recently published results regarding mechanism and efficacy of this novel and promising intervention.

scholarly journals Chronic subthreshold cortical stimulation and stimulation-related EEG biomarkers for focal epilepsy

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Brian Nils Lundstrom ◽  
Jamie Van Gompel ◽  
Fatemeh Khadjevand ◽  
Greg Worrell ◽  
Matt Stead
Keyword(s):  
Spectral Power ◽  
Focal Epilepsy ◽  
Open Loop ◽  
Cortical Stimulation ◽  
Drug Resistant ◽  
Seizure Onset Zone ◽  
Interictal Eeg ◽  
Drug Resistant Epilepsy ◽  
Surrounding Areas

Abstract Brain stimulation offers an alternative to focal resection for the treatment of focal drug-resistant epilepsy. Chronic subthreshold cortical stimulation is an individualized biomarker-informed open-loop continuous electrical stimulation approach targeting the seizure onset zone and surrounding areas. Before permanent implantation, trial stimulation is performed during invasive monitoring to assess stimulation efficacy as well as to optimize stimulation location and parameters by modifying interictal EEG biomarkers. We present clinical and neurophysiological results from a retrospective analysis of 21 patients, showing a median percent reduction in seizure frequency of 100% and responder rate of 89% with a median follow-up of 27 months. About 40% of patients were free of disabling seizures for a 12-month period or longer. We find that stimulation-induced decreases in delta (1–4 Hz) power and increases in alpha and beta (8–20 Hz) power during trial stimulation correlate with improved long-term clinical outcomes. These results suggest chronic subthreshold cortical stimulation may be an effective alternative approach to treating focal drug-resistant epilepsy and that short-term stimulation-related changes in spectral power may be a useful interictal biomarker and relate to long-term clinical outcome.

216 Chronic Subthreshold Cortical Stimulation for Adult Drug Resistant Focal Epilepsy: Safety, Feasibility, and Technique

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 258-259
Author(s):  
Sanjeet Singh Grewal ◽  
Panagiotis Kerezoudis ◽  
Matthew Stead ◽  
Brian N Lundstrom ◽  
Jeffrey Britton ◽  
...  
Keyword(s):  
Life Satisfaction ◽  
Focal Epilepsy ◽  
Cortical Stimulation ◽  
Median Length ◽  
Seizure Severity ◽  
Before And After ◽  
Institutional Experience ◽  
Intracranial Electroencephalography ◽  
Seizure Foci

Abstract INTRODUCTION Epilepsy surgery, while high successful for lesional epilepsy, can be associated with significant morbidity. The objective was to evaluate the safety profile of chronic subthreshold cortical stimulation in patients with seizure foci not amenable to surgical resection. METHODS Patients underwent intracranial electroencephalography monitoring. Those with seizure foci that were deemed unsafe for resection were offered trial of continuous subthreshold cortical stimulation via intracranial monitoring electrodes. After successful trial, trial electrodes were replaced with permanent stimulation. Patients with permanent implantation prior to February, 2016, reported their seizure severity and life satisfaction before and after stimulation. RESULTS >Eight patients from 2014 to 2016 were included in this study. Age ranged (19-56 years). Intracranial pathologies included: cortical dysplasia (n = 3), encephalomalacia (n = 3), cortical tubers (n = 1), and linear migrational anomaly (n = 1). The duration of intracranial monitoring ranged (3-20 days). All patients experienced were discharged to home (median length of stay: 10 days). No postoperative surgical complications have developed to date (median length of follow-up: 187 days). Patients (n = 4) reported a improvement in seizure severity (worst = 10) from mean 7.5 (SE 0.29) to 1.25 (SE 0.75) and life satisfaction (best = 10) from mean 4.25 (SE 1.03) to 7 (SE 1.1), mean follow-up 8.8 months CONCLUSION Our institutional experience shows that chronic cortical stimulation can be safely and effectively performed in appropriately selected patients without postoperative complications. Future investigation will hopefully provide further insight to recently published results into the efficacy of this novel and promising intervention.

scholarly journals Six adult patients with septo-optic dysplasia and drug-resistant epilepsy: Clinical findings and course

2017 ◽  
Vol 8 ◽  
pp. 73-84 ◽  
Author(s):  
Mashael AlKhateeb ◽  
Richard McLachlan ◽  
Jorge Burneo ◽  
David Diosy ◽  
Seyed Mirsattari
Keyword(s):  
Clinical Findings ◽  
Adult Patients ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy

scholarly journals Current approaches to neurosurgical treatment for drug-resistant focal epilepsy in adults

2018 ◽  
Vol 10 (1S) ◽  
pp. 81-88
Author(s):  
E. A. Narodova ◽  
A. A. Narodov ◽  
N. A. Shnayder ◽  
D. V. Dmitrenko ◽  
I. G. Strotskaya
Keyword(s):  
Focal Epilepsy ◽  
Rapid Development ◽  
Adult Population ◽  
Infectious Complications ◽  
High Rate ◽  
Drug Resistant ◽  
Postoperative Rehabilitation ◽  
Foreign Countries ◽  
Neurosurgical Treatment ◽  
Drug Resistant Epilepsy

The review is dedicated to the problems of current neurosurgical treatment for drug-resistant epilepsy in the adult population of Russia and foreign countries. The literature published in the period  2010–2017 was sought in Russian and foreign databases. This  review included 58 only full-text publications. The search results  have shown that despite advances in neurosurgery for drug-resistant epilepsy and the development of new surgical procedures, the  problem of this disease has not yet been fully resolved today. This is  evidenced by fairly high global prevalence rates in patients with  postoperative epilepsy resistant to antiepileptic therapy. The  literature analysis has revealed that the mean prevalence of postoperative epilepsy is 69%. This indicator may vary according  to the type of an epileptogenic structural lesion and its location in  the brain. However, despite the rapid development of epilepsy  surgery, currently there is still a low surgical activity in the treatment  of patients with drugresistant epilepsy. Of importance is  also the presence of postoperative complications, including various  infectious complications and neurological deficit. Taking into account  the high rate of postoperative epilepsy, it is concluded that it is  appropriate to develop postoperative rehabilitation methods for patients with drug-resistant epilepsy.

scholarly journals Drug-resistant focal epilepsy in children is associated with increased modal controllability of the whole brain and epileptogenic regions

2021 ◽  
Author(s):  
Kiran Seunarine ◽  
Xiaosong He ◽  
Martin Tisdall ◽  
Christopher Clark ◽  
Danielle S Bassett ◽  
...  
Keyword(s):  
Diffusion Mri ◽  
Focal Epilepsy ◽  
Brain Network ◽  
Structure And Function ◽  
Network Control ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
And Function ◽  
The Brain ◽  
Disease Understanding

Network control theory provides a framework by which neurophysiological dynamics of the brain can be modelled as a function of the structural connectome constructed from diffusion MRI. Average controllability describes the ability of a region to drive the brain to easy-to-reach neurophysiological states whilst modal controllability describes the ability of a region to drive the brain to difficult-to-reach states. In this study, we identify increases in mean average and modal controllability in children with drug-resistant epilepsy compared to healthy controls. Using simulations, we purport that these changes may be a result of increased thalamocortical connectivity. At the node level, we demonstrate decreased modal controllability in the thalamus and posterior cingulate regions. In those undergoing resective surgery, we also demonstrate increased modal controllability of the resected parcels, a finding specific to patients who were rendered seizure free following surgery. Changes in controllability are a manifestation of brain network dysfunction in epilepsy and may be a useful construct to understand the pathophysiology of this archetypical network disease. Understanding the mechanisms underlying these controllability changes may also facilitate the design of network-focussed interventions that seek to normalise network structure and function.

scholarly journals Retention rate of pregabalin in drug-resistant epilepsy: 1-year follow-up, single-centre observation in 105 consecutive, adult patients

Seizure ◽  
2009 ◽  
Vol 18 (9) ◽  
pp. 634-638 ◽  
Author(s):  
Christian Brandt ◽  
Theodor W. May ◽  
Bernd Pohlmann-Eden ◽  
Esther Nieder ◽  
Heike Elsner ◽  
...  
Keyword(s):  
Retention Rate ◽  
Adult Patients ◽  
Drug Resistant ◽  
Single Centre ◽  
Drug Resistant Epilepsy

scholarly journals The use of perampanel in drug-resistant focal epilepsy: its effect on sleep

2020 ◽  
Vol 12 (6) ◽  
pp. 49-53
Author(s):  
A. A. Filin ◽  
M. V. Tardov ◽  
N. L. Kunelskaya ◽  
P. N. Vlasov
Keyword(s):  
Sleep Quality ◽  
Daytime Sleepiness ◽  
Focal Epilepsy ◽  
Drug Resistant ◽  
Quality Of Sleep ◽  
Night Sleep ◽  
Nocturnal Sleep ◽  
Therapy Regimen ◽  
Drug Resistant Epilepsy

Perampanel (PER) is an antiepileptic drug (AED), the effects of which on sleep have not been studied in Russia.Objective: to assess changes in the quality of sleep, the level of daytime sleepiness, and the polysomnographic (PSG) characteristics of nocturnal sleep in patients with drug-resistant focal epilepsy when PER is incorporated into the therapy regimen as an additional AED.Patients and methods. The investigation enrolled 12 patients (4 men and 8 women) aged 21 to 49 years with drug-resistant epilepsy treated with several AEDs, who had initiated therapy with PER as an additional AED. PSG study and questioning survey were done before and 1 month after initiation of PER therapy.Results and discussion. After one month of PER therapy, there was an increase in the quality of night sleep in 5 cases and a reduction in daytime sleepiness in 6 cases. The PSG pattern was stable in 3 patients, worsened in 1, and improved in 8.Conclusion. The preliminary results suggest that PER therapy improves night sleep quality and reduces daytime sleepiness in about half of the cases, as evidenced by the improved PSG pattern in 67% of patients.

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