Abstract
Summary: There are very few randomized controlled trials studying treatment of super refractory status epilepticus (SE), despite estimated occurrence in about 15% of SE cases and its association with high morbidity and mortality rates. Small case series and case reports have described use of neurostimulation, including vagal nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation, to treat super refractory SE when medical interventions have failed. To our knowledge, this is the first reported case of responsive neurostimulation being used to successfully treat a case of super refractory SE. A 37-year-old man with refractory focal epilepsy and a known focal cortical dysplasia involving motor cortex was implanted with an RNS System device after being in super refractory SE for 20 days. Responsive neurostimulation strip and depth electrodes were placed targeting the cortical dysplasia. Detection and stimulation parameters were adjusted over a 14-day period, as medications were gradually weaned. Seizures abated 15 days after implant, 24 hours after stimulation parameters were configured to mimic seizure offset pattern. Seizure remission was sustained, allowing the patient to be weaned off sedating medications and discharged to a rehabilitation facility. At 6 weeks of follow-up, the patient was near his neurologic baseline with no focal deficits.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 242-245 |
| Number of pages | 4 |
| Journal | Journal of Clinical Neurophysiology |
| Volume | 36 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- Responsive neurostimulation
- Super refractory status epilepticus
ASJC Scopus subject areas
- Physiology
- Neurology
- Clinical Neurology
- Physiology (medical)
Cite this
Novel use of responsive neurostimulation (RNS system) in the treatment of super refractory status epilepticus. / Ernst, Lia D.; Krause, Katie L.; Kellogg, Marissa; Raslan, Ahmed; Spencer, David.
In: Journal of Clinical Neurophysiology, Vol. 36, No. 3, 01.01.2019, p. 242-245.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Novel use of responsive neurostimulation (RNS system) in the treatment of super refractory status epilepticus
AU - Ernst, Lia D.
AU - Krause, Katie L.
AU - Kellogg, Marissa
AU - Raslan, Ahmed
AU - Spencer, David
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Summary: There are very few randomized controlled trials studying treatment of super refractory status epilepticus (SE), despite estimated occurrence in about 15% of SE cases and its association with high morbidity and mortality rates. Small case series and case reports have described use of neurostimulation, including vagal nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation, to treat super refractory SE when medical interventions have failed. To our knowledge, this is the first reported case of responsive neurostimulation being used to successfully treat a case of super refractory SE. A 37-year-old man with refractory focal epilepsy and a known focal cortical dysplasia involving motor cortex was implanted with an RNS System device after being in super refractory SE for 20 days. Responsive neurostimulation strip and depth electrodes were placed targeting the cortical dysplasia. Detection and stimulation parameters were adjusted over a 14-day period, as medications were gradually weaned. Seizures abated 15 days after implant, 24 hours after stimulation parameters were configured to mimic seizure offset pattern. Seizure remission was sustained, allowing the patient to be weaned off sedating medications and discharged to a rehabilitation facility. At 6 weeks of follow-up, the patient was near his neurologic baseline with no focal deficits.
AB - Summary: There are very few randomized controlled trials studying treatment of super refractory status epilepticus (SE), despite estimated occurrence in about 15% of SE cases and its association with high morbidity and mortality rates. Small case series and case reports have described use of neurostimulation, including vagal nerve stimulation, transcranial magnetic stimulation, and deep brain stimulation, to treat super refractory SE when medical interventions have failed. To our knowledge, this is the first reported case of responsive neurostimulation being used to successfully treat a case of super refractory SE. A 37-year-old man with refractory focal epilepsy and a known focal cortical dysplasia involving motor cortex was implanted with an RNS System device after being in super refractory SE for 20 days. Responsive neurostimulation strip and depth electrodes were placed targeting the cortical dysplasia. Detection and stimulation parameters were adjusted over a 14-day period, as medications were gradually weaned. Seizures abated 15 days after implant, 24 hours after stimulation parameters were configured to mimic seizure offset pattern. Seizure remission was sustained, allowing the patient to be weaned off sedating medications and discharged to a rehabilitation facility. At 6 weeks of follow-up, the patient was near his neurologic baseline with no focal deficits.
KW - Responsive neurostimulation
KW - Super refractory status epilepticus
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U2 - 10.1097/WNP.0000000000000541
DO - 10.1097/WNP.0000000000000541
M3 - Article
VL - 36
SP - 242
EP - 245
JO - Journal of Clinical Neurophysiology
JF - Journal of Clinical Neurophysiology
SN - 0736-0258
IS - 3
ER -