Highlights
- •We evaluated seizure reduction, neuropsychiatric and psychosocial outcomes of 50 patients treated with responsive neurostimulation.
- •The 6-month median seizure frequency reduction and responder rate were 88% and 78%, respectively.
- •There was no statistically significant difference at a group level in any of the evaluated cognitive, psychiatric and quality of life outcomes.
- •Meaningful variability at an individual level was noted warranting careful patient selection and monitoring.
Abstract
Objective
The impact of responsive neurostimulation (RNS) on neuropsychiatric and psychosocial
outcomes has not been extensively evaluated outside of the original clinical trials
and post-approval studies. The goal of this study was to ascertain the potential real-world
effects of RNS on cognitive, psychiatric, and quality of life (QOL) outcomes in relation
to seizure outcomes by examining 50 patients undergoing RNS implantation for drug-resistant
epilepsy (DRE).
Methods
We performed a retrospective review of all patients treated at our institution with
RNS for DRE with at least 12 months of follow-up. In addition to baseline demographic
and disease-related characteristics, we collected cognitive (Full-Scale Intelligence
Quotient, Verbal Comprehension, and Perceptual Reasoning Index), psychiatric (Beck
Depression and Anxiety Inventory Scores), and QOL (QOLIE-31) outcomes at 6 and 12 months
after RNS implantation and correlated them with seizure outcomes.
Results
Fifty patients (median age 39.5 years, 64% female) were treated with RNS for DRE in
our institution from 2005 to 2020. Of the 37 of them who had well-documented pre and
post-implantation seizure diaries, the 6-month median seizure frequency reduction
was 88%, the response rate (50% or greater seizure frequency reduction) was 78%, and
32% of patients were free of disabling seizures in this timeframe. There was no statistically
significant difference at a group level in any of the evaluated cognitive, psychiatric,
and QOL outcomes at 6 and 12 months post-implantation compared to the pre-implantation
baseline, irrespective of seizure outcomes, although a subset of patients experienced
a decline in mood or cognitive variables.
Significance
Responsive neurostimulation does not appear to have a statistically significant negative
or positive impact on neuropsychiatric and psychosocial status at the group level.
We observed significant variability in outcome, with a minority of patients experiencing
worse behavioral outcomes, which seemed related to RNS implantation. Careful outcome
monitoring is required to identify the subset of patients experiencing a poor response
and to make appropriate adjustments in care.
Keywords
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Article info
Publication history
Published online: April 17, 2023
Accepted:
March 30,
2023
Received in revised form:
March 5,
2023
Received:
November 23,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
