@article{e9fc2850972b4215a9b57b180ab99603,
title = "Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas",
abstract = "Objective: Evaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with medically intractable partial-onset seizures of neocortical origin. Methods: Patients with partial seizures of neocortical origin were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2–6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. Additional analyses considered safety and seizure reduction according to lobe and functional area (e.g., eloquent cortex) of seizure onset. Results: There were 126 patients with seizures of neocortical onset. The average follow-up was 6.1 implant years. The median percent seizure reduction was 70% in patients with frontal and parietal seizure onsets, 58% in those with temporal neocortical onsets, and 51% in those with multilobar onsets (last observation carried forward [LOCF] analysis). Twenty-six percent of patients experienced at least one seizure-free period of 6 months or longer and 14% experienced at least one seizure-free period of 1 year or longer. Patients with lesions on magnetic resonance imaging (MRI; 77% reduction, LOCF) and those with normal MRI findings (45% reduction, LOCF) benefitted, although the treatment response was more robust in patients with an MRI lesion (p = 0.02, generalized estimating equation [GEE]). There were no differences in the seizure reduction in patients with and without prior epilepsy surgery or vagus nerve stimulation. Stimulation parameters used for treatment did not cause acute or chronic neurologic deficits, even in eloquent cortical areas. The rates of infection (0.017 per patient implant year) and perioperative hemorrhage (0.8%) were not greater than with other neurostimulation devices. Significance: Brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including adults with seizures of neocortical onset, and those with onsets from eloquent cortex.",
keywords = "Brain stimulation, Closed-loop, Eloquent cortex, Neuromodulation, Partial seizures",
author = "Jobst, {Barbara C.} and Ritu Kapur and Barkley, {Gregory L.} and Bazil, {Carl W.} and Berg, {Michel J.} and Bergey, {Gregory K.} and Boggs, {Jane G.} and Cash, {Sydney S.} and Cole, {Andrew J.} and Duchowny, {Michael S.} and Duckrow, {Robert B.} and Edwards, {Jonathan C.} and Stephan Eisenschenk and Fessler, {A. James} and Fountain, {Nathan B.} and Geller, {Eric B.} and Goldman, {Alica M.} and Goodman, {Robert R.} and Gross, {Robert E.} and Gwinn, {Ryder P.} and Christianne Heck and Herekar, {Aamr A.} and Hirsch, {Lawrence J.} and David King-Stephens and Labar, {Douglas R.} and Marsh, {W. R.} and Meador, {Kimford J.} and Ian Miller and Mizrahi, {Eli M.} and Murro, {Anthony M.} and Nair, {Dileep R.} and Noe, {Katherine H.} and Olejniczak, {Piotr W.} and Park, {Yong D.} and Paul Rutecki and Vicenta Salanova and Sheth, {Raj D.} and Christopher Skidmore and Smith, {Michael C.} and Spencer, {David C.} and Shraddha Srinivasan and William Tatum and {Van Ness}, Paul and Vossler, {David G.} and Wharen, {Robert E.} and Worrell, {Gregory A.} and Daniel Yoshor and Zimmerman, {Richard S.} and Skarpaas, {Tara L.} and Morrell, {Martha J.}",
note = "Funding Information: We thank all patients and their families for participating in this study. Baylor College of Medicine: Daniel Friedman, Ian L. Goldsmith, and Amit Verma. California Pacific Medical Center: Kenneth D. Laxer and Peter B. Weber. Columbia University Medical Center: Hyunmi Choi, Derek J. Chong, Daniel Friedman, Steven C. Karceski, Guy M. McKhann, and Anil Mendiratta. Dartmouth-Hitchcock Medical Center: Joshua P. Aronson, Krzysztof A. Bujarski, Ann-Christine Duhaime, Gregory L. Holmes, Erik J. Kobylarz, Richard P. Morse, David W. Roberts, and Vijay M. Thadani. Emory University School of Medicine: Charles M. Epstein, Rebecca Fasano, Raymond E. Faught, Jr., Suzette M. LaRoche, Page B. Pennell, and Andres A. Rodriguez Ruiz. Sandra L. Helmers in memoriam. Henry Ford Hospital: Ellen L. Air, David E. Burdette, Konstantin V. Elisevich, Shailaja Gaddam, Andrea Sneider Hakimi, Madhuri L. Koganti, Amit Ray, Jason M. Schwalb, Brien J. Smith, Marianna V. Spanaki-Varelas, and Vibhangini S. Wasade. Indiana University School of Medicine: Nicholas Barbaro, Omkar N. Markand, Meridith A. Runke, Dragos Sabau, Thomas C. Witt, and Robert M. Worth. Institute of Neurology and Neurosurgery at Saint Barnabas: Orrin Devinsky, Werner K. Doyle, Mangala A. Nadkarni, and Peter P. Widdess-Walsh. Johns Hopkins University School of Medicine: William S. Anderson, George I. Jallo, Eric H. Kossoff, Frederick A. Lenz, and Eva Katharina Ritzl. Keck School of Medicine of USC: Rami G. Apelian, Vidya P. Hawkins, Neda Heidari, Laura A. Kalayjian, Reed L. Levine, Lynn C. Liu, Andrew D. Ly, Johnson L. Moon, Jason S. Muir, George Nune, Ron A. Shatzmiller, Parastou Shilian, and Steven N. Sykes. Louisiana State University School of Medicine in New Orleans: Bruce Fisch, Edward Mader, Joseph Padin, and Nicole R. Villemarette-Pittman. Massachusetts General Hospital: Emad N. Eskandar and Daniel B. Hoch. Mayo Clinic -NDASH- Jacksonville, Florida: David R. Chabolla, Kent C. New, and Jerry J. Shih. Mayo Clinic—Rochester, Minnesota: Jeffrey W. Britton and Gregory D. Cascino. Mayo Clinic -NDASH- Scottsdale, Arizona: Joseph F. Drazkowski, Naresh P. Patel, and Joseph I. Sirven. Medical College of Georgia at Augusta University: Cole A. Giller, Ki Hyeong Lee, Mark R. Lee, Jeffrey M. Politsky, Joseph R. Smith, Suzanne M. Strickland, and Jeffrey A. Switzer. Medical University of South Carolina: Jimmy E. Couch, Steven Glazier, Jonathan J. Halford, Justin M. Nolte, Holly J. Skinner, Mimi Sohn, and William A. Vandergrift. Nicklaus Children's Hospital: Sanjiv Bhatia, Prasanna Jayakar, Glen Morrison, John Ragheb, and Trevor J. Resnick. Oregon Health & Science University: James J. Cereghino, Lia Ernst, Felicia A. Ferguson, Mary M. Ransom, Martin C. Salinsky, and William Brewster Smith. Rush University Medical Center: Donna C. Bergen, Richard W. Byrne, and Marvin A. Rossi. Swedish Medical Center: Lisa M. Caylor, Michael J. Doherty, and John D. Morgan. The Cleveland Clinic Foundation: Andreas V. Alexopoulos, William E. Bingaman, Balu Krishnan, and Imad Michel Najm. Thomas Jefferson University Hospital: James J. Evans, Scott E. Mintzer, Maromi Nei, Ashwini D. Sharan, Michael R. Sperling, and Andro Zangaladze. University of Florida Medical Center: Jeffrey M. Chung, Jean E. Cibula, George A. Ghacibeh, and Steven N. Roper. University of Rochester Medical Center: Guiseppe Erba, Robert A. Gross, John Craig Henry, Charles Y. Liu, Webster H. Pilcher, Jason M. Schwalb, Olga Selioutski, and Thomas Wychowski. University of Texas Southwestern Medical Center: Mark A. Agostini, Sachin Dave, Ramon Diaz-Arrastia, Puneet K. Gupta, Ryan Hays, Bradley Lega, Christopher J. Madden, Pradeep N. Modur, and Louis Anthony Whitworth. University of Virginia School of Medicine: William J. Elias and Mark S. Quigg. University of Wisconsin Hospital and Clinics: Azam S. Ahmed, Mustafa K. Baskaya, Brad R. Beinlich, John C. Jones, Lincoln F. Ramirez, Karl A. Sillay, and Evelyn C. Tunnell. Via Christi Epilepsy Center: Kore K. Liow, Andrew D. Massey, and Nazih Moufarrij. Wake Forest University School of Medicine: William L. Bell, FACP, Mary L. Campagna-Gibson, Daniel E. Couture, Joao Carlos De Toledo, Steven Glazier, Cormac A. O'Donovan, and Maria C. Sam. Weill Cornell Medical College: Theodore H. Schwartz. Yale University School of Medicine: Pue Farooque, Evan J. Fertig, Jason L. Gerrard, Alexander M. Papanastassiou, Dennis D. Spencer, and Kenneth P. Vives. Sandra L. Helmers, Susan S. Spencer, and Thomas L. Ellis, in memoriam. Publisher Copyright: {\textcopyright} 2017 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.",
year = "2017",
month = jun,
doi = "10.1111/epi.13739",
language = "English (US)",
volume = "58",
pages = "1005--1014",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Wiley-Blackwell",
number = "6",
}