TY - JOUR
T1 - Invasive neuromodulation for epilepsy
T2 - Comparison of multiple approaches from a single center
AU - Alcala-Zermeno, Juan Luis
AU - Gregg, Nicholas M.
AU - Starnes, Keith
AU - Mandrekar, Jayawant N.
AU - Van Gompel, Jamie J.
AU - Miller, Kai
AU - Worrell, Greg
AU - Lundstrom, Brian N.
N1 - Funding Information:
Special thanks to Cindy Nelson for her support in patient clinical and neurophysiology follow-up and Melinda Marthaler (NeuroPace Field Engineer) for support and advice related to RNS engineering and programming details. We also acknowledge the important contributions of Dr. Matt Stead (Dark Horse Neuro, Inc.) to our neuromodulation patients. The research was supported by the National Institutes of Health National Institute of Neurological Disorders and Stroke: K23NS112339 (B.N.L.), JLAZ reviewed the medical records, performed the telephone survey, wrote the initial draft, and performed the statistical analyses. BNL participated in all aspects of the work and provided supervision. JNM performed the regression analyses. All authors contributed to the conception of the work or data acquisition and critically revised the manuscript, and approved the final version.
Funding Information:
The research was supported by the National Institutes of Health National Institute of Neurological Disorders and Stroke: K23NS112339 (B.N.L.)
Publisher Copyright:
© 2022
PY - 2022/12
Y1 - 2022/12
N2 - Background: Drug-resistant epilepsy (DRE) patients not amenable to epilepsy surgery can benefit from neurostimulation. Few data compare different neuromodulation strategies. Objective: Compare five invasive neuromodulation strategies for the treatment of DRE: anterior thalamic nuclei deep brain stimulation (ANT-DBS), centromedian thalamic nuclei DBS (CM-DBS), responsive neurostimulation (RNS), chronic subthreshold stimulation (CSS), and vagus nerve stimulation (VNS). Methods: Single center retrospective review and phone survey for patients implanted with invasive neuromodulation for 2004–2021. Results: N = 159 (ANT-DBS = 38, CM-DBS = 19, RNS = 30, CSS = 32, VNS = 40). Total median seizure reduction (MSR) was 61 % for the entire cohort (IQR 5–90) and in descending order: CSS (85 %), CM-DBS (63 %), ANT-DBS (52 %), RNS (50 %), and VNS (50 %); p = 0.07. The responder rate was 60 % after a median follow-up time of 26 months. Seizure severity, life satisfaction, and quality of sleep were improved. Cortical stimulation (RNS and CSS) was associated with improved seizure reduction compared to subcortical stimulation (ANT-DBS, CM-DBS, and VNS) (67 % vs. 52 %). Effectiveness was similar for focal epilepsy vs. generalized epilepsy, closed-loop vs. open-loop stimulation, pediatric vs. adult cases, and high frequency (>100 Hz) vs. low frequency (<100 Hz) stimulation settings. Delivered charge per hour varied widely across approaches but was not correlated with improved seizure reduction. Conclusions: Multiple invasive neuromodulation approaches are available to treat DRE, but little evidence compares the approaches. This study used a uniform approach for single-center results and represents an effort to compare neuromodulation approaches.
AB - Background: Drug-resistant epilepsy (DRE) patients not amenable to epilepsy surgery can benefit from neurostimulation. Few data compare different neuromodulation strategies. Objective: Compare five invasive neuromodulation strategies for the treatment of DRE: anterior thalamic nuclei deep brain stimulation (ANT-DBS), centromedian thalamic nuclei DBS (CM-DBS), responsive neurostimulation (RNS), chronic subthreshold stimulation (CSS), and vagus nerve stimulation (VNS). Methods: Single center retrospective review and phone survey for patients implanted with invasive neuromodulation for 2004–2021. Results: N = 159 (ANT-DBS = 38, CM-DBS = 19, RNS = 30, CSS = 32, VNS = 40). Total median seizure reduction (MSR) was 61 % for the entire cohort (IQR 5–90) and in descending order: CSS (85 %), CM-DBS (63 %), ANT-DBS (52 %), RNS (50 %), and VNS (50 %); p = 0.07. The responder rate was 60 % after a median follow-up time of 26 months. Seizure severity, life satisfaction, and quality of sleep were improved. Cortical stimulation (RNS and CSS) was associated with improved seizure reduction compared to subcortical stimulation (ANT-DBS, CM-DBS, and VNS) (67 % vs. 52 %). Effectiveness was similar for focal epilepsy vs. generalized epilepsy, closed-loop vs. open-loop stimulation, pediatric vs. adult cases, and high frequency (>100 Hz) vs. low frequency (<100 Hz) stimulation settings. Delivered charge per hour varied widely across approaches but was not correlated with improved seizure reduction. Conclusions: Multiple invasive neuromodulation approaches are available to treat DRE, but little evidence compares the approaches. This study used a uniform approach for single-center results and represents an effort to compare neuromodulation approaches.
KW - Chronic subthreshold stimulation
KW - Deep brain stimulation
KW - Low-frequency stimulation
KW - Neurostimulation
KW - Responsive neurostimulation
KW - Vagus nerve stimulation
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U2 - 10.1016/j.yebeh.2022.108951
DO - 10.1016/j.yebeh.2022.108951
M3 - Article
C2 - 36327647
AN - SCOPUS:85140650679
SN - 1525-5050
VL - 137
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
M1 - 108951
ER -