Dual responsive neurostimulation implants for epilepsy

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  • 1 Departments of Neurosurgery and
  • 3 Neurology, University of Southern California, Keck School of Medicine, Los Angeles; and
  • 2 Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, California
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Closed-loop brain-responsive neurostimulation via the RNS System is a treatment option for adults with medically refractory focal epilepsy. Using a novel technique, 2 RNS Systems (2 neurostimulators and 4 leads) were successfully implanted in a single patient with bilateral parietal epileptogenic zones. In patients with multiple epileptogenic zones, this technique allows for additional treatment options. Implantation can be done successfully, without telemetry interference, using proper surgical planning and neurostimulator positioning.

Trajectories for the depth leads were planned using neuronavigation with CT and MR imaging. Stereotactic frames were used for coordinate targeting. Each neurostimulator was positioned with maximal spacing to avoid telemetry interference while minimizing patient discomfort. A separate J-shaped incision was used for each neurostimulator to allow for compartmentalization in case of infection. In order to minimize surgical time and risk of infection, the neurostimulators were implanted in 2 separate surgeries, approximately 3 weeks apart.

The neurostimulators and leads were successfully implanted without adverse surgical outcomes. The patient recovered uneventfully, and the early therapy settings over several months resulted in preliminary decreases in aura and seizure frequency. Stimulation by one of the neurostimulators did not result in stimulation artifacts detected by the contralateral neurostimulator.

ABBREVIATIONS ECoG = electrocorticography; EEG = electroencephalography; FCD = focal cortical dysplasia.

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Contributor Notes

Correspondence Michael F. Barbaro: University of Southern California, Keck School of Medicine, Los Angeles, CA. mbarbaro@usc.edu.

INCLUDE WHEN CITING Published online January 25, 2019; DOI: 10.3171/2018.8.JNS181362.

Disclosures Ms. Greenwood: direct stock ownership in and former employee of NeuroPace. Dr. Nune: coinvestigator in an ongoing NeuroPace clinical trial and collaborator with NeuroPace on other ongoing research.

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