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Invasive neuromodulation for epilepsy: Comparison of multiple approaches from a single center

Published:October 27, 2022DOI:https://doi.org/10.1016/j.yebeh.2022.108951

      Highlights

      • Single center report of 5 invasive neuromodulation strategies for epilepsy.
      • ANT-DBS, CM-DBS, RNS, and VNS had similar seizure reductions.
      • Cortical stimulation may be more effective than subcortical stimulation for epilepsy.
      • Low-frequency stimulation may be effective for seizure reduction in DBS, RNS, and CSS.
      • Seizure reduction was similar for open vs. closed-loop stimulation and pediatric vs. adult patients.

      Abstract

      Background

      Drug-resistant epilepsy (DRE) patients not amenable to epilepsy surgery can benefit from neurostimulation. Few data compare different neuromodulation strategies.

      Objective

      Compare five invasive neuromodulation strategies for the treatment of DRE: anterior thalamic nuclei deep brain stimulation (ANT-DBS), centromedian thalamic nuclei DBS (CM-DBS), responsive neurostimulation (RNS), chronic subthreshold stimulation (CSS), and vagus nerve stimulation (VNS).

      Methods

      Single center retrospective review and phone survey for patients implanted with invasive neuromodulation for 2004–2021.

      Results

      N = 159 (ANT-DBS = 38, CM-DBS = 19, RNS = 30, CSS = 32, VNS = 40). Total median seizure reduction (MSR) was 61 % for the entire cohort (IQR 5–90) and in descending order: CSS (85 %), CM-DBS (63 %), ANT-DBS (52 %), RNS (50 %), and VNS (50 %); p = 0.07. The responder rate was 60 % after a median follow-up time of 26 months. Seizure severity, life satisfaction, and quality of sleep were improved. Cortical stimulation (RNS and CSS) was associated with improved seizure reduction compared to subcortical stimulation (ANT-DBS, CM-DBS, and VNS) (67 % vs. 52 %). Effectiveness was similar for focal epilepsy vs. generalized epilepsy, closed-loop vs. open-loop stimulation, pediatric vs. adult cases, and high frequency (>100 Hz) vs. low frequency (<100 Hz) stimulation settings. Delivered charge per hour varied widely across approaches but was not correlated with improved seizure reduction.

      Conclusions

      Multiple invasive neuromodulation approaches are available to treat DRE, but little evidence compares the approaches. This study used a uniform approach for single-center results and represents an effort to compare neuromodulation approaches.

      Keywords

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