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John D. Rolston, Dario J. Englot, Doris D. Wang, Tina Shih, and Edward F. Chang

directly related to the device in the SANTE trial included paresthesias in 18.2%, implant site pain in 10.9%, implant site infections in 9.1%, and lead replacement in 8.2% of patients. Note that these frequencies include the unblinded portion of the trial—the adverse events in the blinded portion are displayed in Table 2 . Adverse events that were significantly different between groups in the blinded phase were depression (14.8% of treated patients) and memory impairment (13.0%). Responsive Neurostimulation The RNS device is designed to detect seizures as they

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Neil Klinger and Sandeep Mittal

separate study of 12 patients with intractable epilepsy treated with cerebellar stimulation, no reduction in seizure frequency was reported at 6 months. 75 Responsive Neurostimulation Responsive neurostimulation (RNS) is a unique implantable electrical current delivery method that does not rely on continuous or predefined intermittent stimulation paradigms. The treating physician programs the RNS device to recognize electrocorticographic (ECoG) patterns unique to the patient that may occur prior to ictal onset. When the patient subsequently experiences similar ECoG

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Allen L. Ho, Anne-Mary N. Salib, Arjun V. Pendharkar, Eric S. Sussman, William J. Giardino, and Casey H. Halpern

responsive neurostimulation systems in the treatment of epilepsy has demonstrated the effectiveness of “closed-loop” recording and intermittent stimulation systems for the treatment of episodic electrical pathology within the brain. 45 Consumption-driven disorders of impulsivity may be ideal for this type of closed-loop treatment if stimulation could be delivered during brief windows of anticipation, or so-called moments of weakness prior to the initiation of a binge. 8 , 60 Wu et al. recently published a translational study validating this technique. They were able to

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Robert G. Grossman, Charles Y. Liu, and Amit Verma

of resection in posttraumatic epilepsy). Articles 11–14: neuromodulation is discussed by Dlouhy (lead revision in vagal nerve stimulation), by Guthikonda (vagal nerve stimulation literature review), by Yoshor (brain stimulation), and by Chang (comparison of vagus nerve, thalamic deep brain stimulation, and responsive neurostimulation). Disclosure Dr. Liu is a consultant for Integra, and Dr. Verma has served on the speakers bureau for Cyberonics.

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Nasir Raza Awan, Andres Lozano, and Clement Hamani

-called external responsive neurostimulation system used in epilepsy include depth and strip electrodes, a pulse generator, and external devices (programmer, data transmitter, and telemetry wand). 29 , 87 Electrodes initially record local field potentials or cortical activity. Signals are then sent to a microprocessor in the generator, which stores ECoG signals. Upon detection of epileptiform events, responsive therapy (electrical stimulation) is delivered. Signals are then once again recorded and processed to assess whether epileptogenic activity is still present. If so, the

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Nir Lipsman, Michael Ellis, and Andres M. Lozano

Responsive Neurostimulation System (Neuropace Inc.) in adults with medically refractory partial-onset seizures, 47% of patients experienced a 50% or greater reduction in seizure frequency. 40 Given all these data, the future of DBS for medically refractory epilepsy is encouraging and will hopefully provide important alternative treatment options for children with debilitating seizure disorders. The ideal targets and stimulator parameters for individual seizure disorders will be better appreciated as larger collaborative studies are completed. Given the significant long

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Brandon G. Rocque, Matthew C. Davis, Samuel G. McClugage III, Dang Anh Tuan, Donald T. King III, Nguyen Thi Huong, Nguyen Thi Bich Van, Pongkiat Kankirawatana, Cao Vu Hung, Le Nam Thang, James M. Johnston, and Nguyen Duc Lien

advances have expanded the armamentarium of epilepsy surgeons, diffusion of these techniques to the less-developed world has been limited. Many of these technological innovations are unavailable to most patients in Vietnam, including MRI-guided laser interstitial thermal therapy, 31 responsive neurostimulation, 16 , 22 and vagus nerve stimulation. 14 However, the development of a comprehensive epilepsy program does not require the availability of every technological product at the outset. As the program grows, these and other new technical advancements will continue

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Sanjeet S. Grewal, Erik H. Middlebrooks, Timothy J. Kaufmann, Matthew Stead, Brian N. Lundstrom, Gregory A. Worrell, Chen Lin, Serhat Baydin, and Jamie J. Van Gompel

F or patients with medically refractory focal epilepsy, surgical interventions include resection, ablation, or neuromodulation. The latter can be performed through vagus nerve stimulation, 31 responsive neurostimulation, 3 chronic subthreshold cortical stimulation, 16 , 22 and deep brain stimulation (DBS). 21 While many sites have been tested for DBS, including the centromedian nucleus of the thalamus (CMT), 21 the most rigorously studied site is the anterior nucleus of the thalamus (ANT). 7 Targeting the ANT has traditionally been accomplished using

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Abhijeet Gummadavelli, Adam J. Kundishora, Jon T. Willie, John P. Andrews, Jason L. Gerrard, Dennis D. Spencer, and Hal Blumenfeld

Anterior Nucleus of Thalamus for Epilepsy trial) and DBS of neocortical or mesial temporal structures (Responsive Neurostimulation trial). 27 , 60 To date, however, such studies have not addressed whether neurostimulation might specifically restore an impaired level of consciousness when the patient is in the ictal or postictal states. Minimizing the effects of seizures on consciousness or enhancing cognition in the postictal brain presents unique challenges for scientific exploration and fertile opportunities for novel therapies, possibly by DBS or related

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Sumeet Vadera, Alvin Y. Chan, Lilit Mnatsankanyan, Mona Sazgar, Indranil Sen-Gupta, Jack Lin, and Frank P. K. Hsu

patients. All imaging studies, vEEG data, neuropsychological testing data, and clinical findings were discussed. A treatment consensus was reached among all members of the group and tailored to the patient’s unique clinical presentation. Surgical procedures included resective surgery, implantation of depth electrodes for stereo-encephalography (SEEG), implantation of subdural grid electrodes (SDGs) for SDG-based EEG, implantation of responsive neurostimulation (RNS) systems, implantation of vagus nerve stimulation (VNS) devices, laser ablation, and palliative surgeries