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

Barbara C. Jobst, Ritu Kapur, Gregory L. Barkley, Carl W. Bazil, Michel J. Berg, Gregory K. Bergey, Jane G. Boggs, Sydney S. Cash, Andrew J. Cole, Michael S. Duchowny, Robert B. Duckrow, Jonathan C. Edwards, Stephan Eisenschenk, A. James Fessler, Nathan B. Fountain, Eric B. Geller, Alica M. Goldman, Robert R. Goodman, Robert E. Gross, Ryder P. Gwinn & 30 others Christianne Heck, Aamr A. Herekar, Lawrence J. Hirsch, David King-Stephens, Douglas R. Labar, W. R. Marsh, Kimford J. Meador, Ian Miller, Eli M. Mizrahi, Anthony M. Murro, Dileep R. Nair, Katherine H. Noe, Piotr W. Olejniczak, Yong D. Park, Paul Rutecki, Vicenta Salanova, Raj D. Sheth, Christopher Skidmore, Michael C. Smith, David Spencer, Shraddha Srinivasan, William Tatum, Paul Van Ness, David G. Vossler, Robert E. Wharen, Gregory A. Worrell, Daniel Yoshor, Richard S. Zimmerman, Tara L. Skarpaas, Martha J. Morrell

Research output: Contribution to journalArticle

45 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1005-1014
Number of pages10
JournalEpilepsia
Volume58
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Seizures
Brain
Observation
Safety
Vagus Nerve Stimulation
Neurologic Manifestations
Epilepsy
Therapeutics
Magnetic Resonance Imaging
Clinical Trials
Hemorrhage
Equipment and Supplies

Keywords

  • Brain stimulation
  • Closed-loop
  • Eloquent cortex
  • Neuromodulation
  • Partial seizures

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Jobst, B. C., Kapur, R., Barkley, G. L., Bazil, C. W., Berg, M. J., Bergey, G. K., ... Morrell, M. J. (2017). Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas. Epilepsia, 58(6), 1005-1014. https://doi.org/10.1111/epi.13739

Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas. / 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.; Gwinn, Ryder P.; Heck, Christianne; Herekar, Aamr A.; Hirsch, Lawrence J.; King-Stephens, David; Labar, Douglas R.; Marsh, W. R.; Meador, Kimford J.; Miller, Ian; Mizrahi, Eli M.; Murro, Anthony M.; Nair, Dileep R.; Noe, Katherine H.; Olejniczak, Piotr W.; Park, Yong D.; Rutecki, Paul; Salanova, Vicenta; Sheth, Raj D.; Skidmore, Christopher; Smith, Michael C.; Spencer, David; Srinivasan, Shraddha; Tatum, William; Van Ness, Paul; Vossler, David G.; Wharen, Robert E.; Worrell, Gregory A.; Yoshor, Daniel; Zimmerman, Richard S.; Skarpaas, Tara L.; Morrell, Martha J.

In: Epilepsia, Vol. 58, No. 6, 01.06.2017, p. 1005-1014.

Research output: Contribution to journalArticle

Jobst, BC, Kapur, R, Barkley, GL, Bazil, CW, Berg, MJ, Bergey, GK, Boggs, JG, Cash, SS, Cole, AJ, Duchowny, MS, Duckrow, RB, Edwards, JC, Eisenschenk, S, Fessler, AJ, Fountain, NB, Geller, EB, Goldman, AM, Goodman, RR, Gross, RE, Gwinn, RP, Heck, C, Herekar, AA, Hirsch, LJ, King-Stephens, D, Labar, DR, Marsh, WR, Meador, KJ, Miller, I, Mizrahi, EM, Murro, AM, Nair, DR, Noe, KH, Olejniczak, PW, Park, YD, Rutecki, P, Salanova, V, Sheth, RD, Skidmore, C, Smith, MC, Spencer, D, Srinivasan, S, Tatum, W, Van Ness, P, Vossler, DG, Wharen, RE, Worrell, GA, Yoshor, D, Zimmerman, RS, Skarpaas, TL & Morrell, MJ 2017, 'Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas', Epilepsia, vol. 58, no. 6, pp. 1005-1014. https://doi.org/10.1111/epi.13739
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. ; Gwinn, Ryder P. ; Heck, Christianne ; Herekar, Aamr A. ; Hirsch, Lawrence J. ; King-Stephens, David ; Labar, Douglas R. ; Marsh, W. R. ; Meador, Kimford J. ; Miller, Ian ; Mizrahi, Eli M. ; Murro, Anthony M. ; Nair, Dileep R. ; Noe, Katherine H. ; Olejniczak, Piotr W. ; Park, Yong D. ; Rutecki, Paul ; Salanova, Vicenta ; Sheth, Raj D. ; Skidmore, Christopher ; Smith, Michael C. ; Spencer, David ; Srinivasan, Shraddha ; Tatum, William ; Van Ness, Paul ; Vossler, David G. ; Wharen, Robert E. ; Worrell, Gregory A. ; Yoshor, Daniel ; Zimmerman, Richard S. ; Skarpaas, Tara L. ; Morrell, Martha J. / Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas. In: Epilepsia. 2017 ; Vol. 58, No. 6. pp. 1005-1014.
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T1 - Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas

AU - Jobst, Barbara C.

AU - Kapur, Ritu

AU - Barkley, Gregory L.

AU - Bazil, Carl W.

AU - Berg, Michel J.

AU - Bergey, Gregory K.

AU - Boggs, Jane G.

AU - Cash, Sydney S.

AU - Cole, Andrew J.

AU - Duchowny, Michael S.

AU - Duckrow, Robert B.

AU - Edwards, Jonathan C.

AU - Eisenschenk, Stephan

AU - Fessler, A. James

AU - Fountain, Nathan B.

AU - Geller, Eric B.

AU - Goldman, Alica M.

AU - Goodman, Robert R.

AU - Gross, Robert E.

AU - Gwinn, Ryder P.

AU - Heck, Christianne

AU - Herekar, Aamr A.

AU - Hirsch, Lawrence J.

AU - King-Stephens, David

AU - Labar, Douglas R.

AU - Marsh, W. R.

AU - Meador, Kimford J.

AU - Miller, Ian

AU - Mizrahi, Eli M.

AU - Murro, Anthony M.

AU - Nair, Dileep R.

AU - Noe, Katherine H.

AU - Olejniczak, Piotr W.

AU - Park, Yong D.

AU - Rutecki, Paul

AU - Salanova, Vicenta

AU - Sheth, Raj D.

AU - Skidmore, Christopher

AU - Smith, Michael C.

AU - Spencer, David

AU - Srinivasan, Shraddha

AU - Tatum, William

AU - Van Ness, Paul

AU - Vossler, David G.

AU - Wharen, Robert E.

AU - Worrell, Gregory A.

AU - Yoshor, Daniel

AU - Zimmerman, Richard S.

AU - Skarpaas, Tara L.

AU - Morrell, Martha J.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - 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.

AB - 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.

KW - Brain stimulation

KW - Closed-loop

KW - Eloquent cortex

KW - Neuromodulation

KW - Partial seizures

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