scholarly journals Chronic subthreshold cortical stimulation and stimulation-related EEG biomarkers for focal epilepsy

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Brian Nils Lundstrom ◽  
Jamie Van Gompel ◽  
Fatemeh Khadjevand ◽  
Greg Worrell ◽  
Matt Stead
Keyword(s):  
Spectral Power ◽  
Focal Epilepsy ◽  
Open Loop ◽  
Cortical Stimulation ◽  
Drug Resistant ◽  
Seizure Onset Zone ◽  
Interictal Eeg ◽  
Drug Resistant Epilepsy ◽  
Surrounding Areas

Abstract Brain stimulation offers an alternative to focal resection for the treatment of focal drug-resistant epilepsy. Chronic subthreshold cortical stimulation is an individualized biomarker-informed open-loop continuous electrical stimulation approach targeting the seizure onset zone and surrounding areas. Before permanent implantation, trial stimulation is performed during invasive monitoring to assess stimulation efficacy as well as to optimize stimulation location and parameters by modifying interictal EEG biomarkers. We present clinical and neurophysiological results from a retrospective analysis of 21 patients, showing a median percent reduction in seizure frequency of 100% and responder rate of 89% with a median follow-up of 27 months. About 40% of patients were free of disabling seizures for a 12-month period or longer. We find that stimulation-induced decreases in delta (1–4 Hz) power and increases in alpha and beta (8–20 Hz) power during trial stimulation correlate with improved long-term clinical outcomes. These results suggest chronic subthreshold cortical stimulation may be an effective alternative approach to treating focal drug-resistant epilepsy and that short-term stimulation-related changes in spectral power may be a useful interictal biomarker and relate to long-term clinical outcome.

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

2018 ◽  
Vol 129 (2) ◽  
pp. 533-543 ◽  
Author(s):  
Panagiotis Kerezoudis ◽  
Sanjeet S. Grewal ◽  
Matthew Stead ◽  
Brian Nils Lundstrom ◽  
Jeffrey W. Britton ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Cortical Stimulation ◽  
Adult Patients ◽  
Therapeutic Trial ◽  
Drug Resistant ◽  
Surgical Safety ◽  
Institutional Experience ◽  
Eloquent Cortex ◽  
Drug Resistant Epilepsy ◽  
Seizure Foci

OBJECTIVEEpilepsy 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.METHODSAdult 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.RESULTSTen 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.CONCLUSIONSThe 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.

scholarly journals Distributed Brain Co-Processor for Neurophysiologic Tracking and Adaptive Stimulation: Application to Drug Resistant Epilepsy

2021 ◽  
Author(s):  
Vladimir Sladky ◽  
Petr Nejedly ◽  
Filip Mivalt ◽  
Benjamin H. Brinkmann ◽  
Inyong Kim ◽  
...  
Keyword(s):  
Data Storage ◽  
Brain Stimulation ◽  
Open Loop ◽  
Natural Environments ◽  
Drug Resistant ◽  
Embedded Computing ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Drug Resistant Epilepsy

AbstractElectrical brain stimulation is a proven therapy for epilepsy, but long-term seizure free outcomes are rare. Early implantable devices were developed for open-loop stimulation without sensing, embedded computing or adaptive therapy. Recent device advances include sensing and closed-loop responsive stimulation, but these clinically available devices lack adequate computing, data storage and patient interface to concisely catalog behavior, seizures, and brain electrophysiology, despite the critical importance of these details for epilepsy management. Here we describe the first application of a distributed brain co-processor providing an intuitive, bi-directional interface between device implant, patient & physician, and implement it in human and canine patients with epilepsy living in their natural environments. Automated behavioral state tracking (awake and sleep) and electrophysiologic classifiers for interictal epileptiform discharges and electrographic seizures are run on local hand-held and distributed cloud computing resources to guide adaptive electrical stimulation. These algorithms were first developed and parameterized using long-term retrospective data from 10 humans and 11 canines with epilepsy and then implemented prospectively in two pet canines and one human with drug resistant epilepsy as they naturally navigate their lives in society.One Sentence SummaryWe created a distributed brain co-processor for continuous neurophysiologic tracking and controlling adaptive brain stimulation to treat epilepsy.

scholarly journals Successful treatment with adjunctive lacosamide in a patient with long term “drug resistant” focal epilepsy

2014 ◽  
Vol 22 (1) ◽  
pp. 51-55
Author(s):  
Walter Fröscher ◽  
Alois Rauber
Keyword(s):  
Case Report ◽  
Focal Epilepsy ◽  
Adjunctive Treatment ◽  
High Dose ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Off Label ◽  
Number Of Patients ◽  
Drug Resistant Epilepsy

SUMMARY Introduction. A significant number of patients suffering from epilepsy prove to be resistant to antiepileptic drugs (AEDs). Recent studies, however, suggest that 10–20% of seemingly drug resistant patients may still become seizure-free under the influence of subsequent dosage modifications. Case report. We report on a young man with cryptogenic focal epilepsy. He had his first seizure at the age of fifteen. His seizure frequency was decreased during the following 11 years. However, seizure-freedom was never achieved even though he was treated with twelve to fourteen different AEDs during this time. Intensive presurgical evaluations did not allow identification of a surgically remediable focus. Adjunctive treatment with lacosamide 400 mg/day was not successful. However, the patient became seizure-free immediately after an increase of the lacosamide dose up to 500 mg/day. The patient is now seizure-free for more than two years based on a combination of 500 mg lacosamide and 350 mg lamotrigine, followed by 550 mg and 250 mg, respectively. Discussion and conclusion. This case report highlights that there is always a chance that modifying the medication can result in a drug-resistant epilepsy patient experiencing a significant reduction of seizures and becoming seizure-free. The decisive step in this example was the off-label prescription of a high dose of lacosamide which the patient tolerated well.

Vagus nerve stimulation for drug-resistant epilepsy

2019 ◽  
Vol 20 (3) ◽  
pp. 189-198 ◽  
Author(s):  
Laura Pérez-Carbonell ◽  
Howard Faulkner ◽  
Sean Higgins ◽  
Michalis Koutroumanidis ◽  
Guy Leschziner
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Therapeutic Option ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
Randomised Controlled

Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%–40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory results. Although initially designed for managing focal seizures, its use has been extended to other forms of drug-resistant epilepsy. In this review, we discuss the evidence supporting the use of VNS, its impact on seizure frequency and quality of life, and common adverse effects of this therapy. We also include practical guidance for the approach to and the management of patients with VNS in situ.

Long-term effectiveness and adverse effects of ketogenic diet therapy in infants with drug-resistant epilepsy treated at a single center in Argentina

2021 ◽  
pp. 106793
Author(s):  
Marisa Armeno ◽  
Antonella Verini ◽  
Eugenia Caballero ◽  
Araceli Cresta ◽  
Gabriela Reyes Valenzuela ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Ketogenic Diet ◽  
Diet Therapy ◽  
Drug Resistant ◽  
Single Center ◽  
Drug Resistant Epilepsy

scholarly journals Long-Term Effects of a Classic Ketogenic Diet on Ghrelin and Leptin Concentration: A 12-Month Prospective Study in a Cohort of Italian Children and Adults with GLUT1-Deficiency Syndrome and Drug Resistant Epilepsy

Nutrients ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1716 ◽  
Author(s):  
Ramona De Amicis ◽  
Alessandro Leone ◽  
Chiara Lessa ◽  
Andrea Foppiani ◽  
Simone Ravella ◽  
...  
Keyword(s):  
Body Composition ◽  
Nutritional Status ◽  
Body Fat ◽  
Deficiency Syndrome ◽  
Drug Resistant ◽  
Z Score ◽  
Glut1 Deficiency ◽  
Glut1 Deficiency Syndrome ◽  
Drug Resistant Epilepsy

The classical ketogenic diet (cKD) is an isocaloric, high fat, very low-carbohydrate diet that induces ketosis, strongly influencing leptin and ghrelin regulation. However, not enough is known about the impact of a long-term cKD. This study evaluated the effects of a 12-month cKD on ghrelin and leptin concentrations in children, adolescents and adults affected by the GLUT1-Deficiency Syndrome or drug resistant epilepsy (DRE). We also investigated the relationship between the nutritional status, body composition and ghrelin and leptin variations. We carried out a longitudinal study on 30 patients: Twenty-five children and adolescents (15 females, 8 ± 4 years), and five adults (two females, 34 ± 16 years). After 12-monoths cKD, there were no significant changes in ghrelin and leptin, or in the nutritional status, body fat, glucose and lipid profiles. However, a slight height z-score reduction (from −0.603 ± 1.178 to −0.953 ± 1.354, p ≤ 0.001) and a drop in fasting insulin occurred. We found no correlations between ghrelin changes and nutritional status and body composition, whereas leptin changes correlated positively with variations in the weight z-score and body fat (ρ = 0.4534, p = 0.0341; ρ = 0.5901, p = 0.0135; respectively). These results suggest that a long-term cKD does not change ghrelin and leptin concentrations independently of age and neurological condition.

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