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

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OBJECTIVE

Epilepsy 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.

METHODS

Adult 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.

RESULTS

Ten 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.

CONCLUSIONS

The 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.

ABBREVIATIONS CSCS = chronic subthreshold cortical stimulation; iEEG = intracranial electroencephalography; RNS = responsive neurostimulation; SOZ = seizure onset zone.
Article Information

Contributor Notes

Correspondence Jamie J. Van Gompel, Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. email: vangompel.jamie@mayo.edu.INCLUDE WHEN CITING Published online October 20, 2017; DOI: 10.3171/2017.5.JNS163134.Disclosures Drs. Stead, Brinkmann, Worrell, and Van Gompel report receiving support from an NIH-funded public-private partnership grant (no. UH2-NS095495) between Mayo Clinic and Medtronic, and a Medtronic-supported investigational device exemption study. The patients in this report received treatment based on compassionate, off-label use with commercially available, FDA-approved devices.

© AANS, except where prohibited by US copyright law.

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