Dual responsive neurostimulation implants for epilepsy

Restricted access

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.
Article Information

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.
Headings
References
  • 1

    Anderson WSKossoff EHBergey GKJallo GI: Implantation of a responsive neurostimulator device in patients with refractory epilepsy. Neurosurg Focus 25(3):E122008

    • Search Google Scholar
    • Export Citation
  • 2

    Fountas KNSmith JRMurro AMPolitsky JPark YDJenkins PD: Implantation of a closed-loop stimulation in the management of medically refractory focal epilepsy: a technical note. Stereotact Funct Neurosurg 83:1531582005

    • Search Google Scholar
    • Export Citation
  • 3

    Kossoff EHRitzl EKPolitsky JMMurro AMSmith JRDuckrow RB: Effect of an external responsive neurostimulator on seizures and electrographic discharges during subdural electrode monitoring. Epilepsia 45:156015672004

    • Search Google Scholar
    • Export Citation
  • 4

    Kramer DRHalpern CHBuonacore DLMcGill KRHurtig HIJaggi JL: Best surgical practices: a stepwise approach to the University of Pennsylvania deep brain stimulation protocol. Neurosurg Focus 29(2):E32010

    • Search Google Scholar
    • Export Citation
  • 5

    Lee BZubair MNMarquez YDLee DMKalayjian LAHeck CN: A single-center experience with the NeuroPace RNS System: a review of techniques and potential problems. World Neurosurg 84:7197262015

    • Search Google Scholar
    • Export Citation
  • 6

    Leone MASolari ABeghi E: Treatment of the first tonic-clonic seizure does not affect long-term remission of epilepsy. Neurology 67:222722292006

    • Search Google Scholar
    • Export Citation
  • 7

    Liu CWen XWGe YChen NHu WHZhang T: Responsive neurostimulation for the treatment of medically intractable epilepsy. Brain Res Bull 97:39472013

    • Search Google Scholar
    • Export Citation
  • 8

    Marson AJacoby AJohnson AKim LGamble CChadwick D: Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet 365:200720132005

    • Search Google Scholar
    • Export Citation
  • 9

    Morrell MJ: Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology 77:129513042011

  • 10

    Murro APark YBergey GKossof ERitzl EKarceski S: Multicenter study of acute responsive stimulation in patients with intractable epilepsy. Epilepsia 44 (Suppl 9):3262003 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 11

    Neligan AHauser WASander JW: The epidemiology of the epilepsies. Handb Clin Neurol 107:1131332012

  • 12

    Osorio IFrei MGManly BFSunderam SBhavaraju NCWilkinson SB: An introduction to contingent (closed-loop) brain electrical stimulation for seizure blockage, to ultra-short-term clinical trials, and to multidimensional statistical analysis of therapeutic efficacy. J Clin Neurophysiol 18:5335442001

    • Search Google Scholar
    • Export Citation
  • 13

    Schmidt DStavem K: Long-term seizure outcome of surgery versus no surgery for drug-resistant partial epilepsy: a review of controlled studies. Epilepsia 50:130113092009

    • Search Google Scholar
    • Export Citation
  • 14

    Sun FTMorrell MJ: The RNS System: responsive cortical stimulation for the treatment of refractory partial epilepsy. Expert Rev Med Devices 11:5635722014

    • Search Google Scholar
    • Export Citation
  • 15

    Téllez-Zenteno JFDhar RHernandez-Ronquillo LWiebe S: Long-term outcomes in epilepsy surgery: antiepileptic drugs, mortality, cognitive and psychosocial aspects. Brain 130:3343452007

    • Search Google Scholar
    • Export Citation
  • 16

    Wiebe SBlume WTGirvin JPEliasziw M: A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 345:3113182001

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 71 71 71
Full Text Views 15 15 15
PDF Downloads 26 26 26
EPUB Downloads 0 0 0
PubMed
Google Scholar