Implantation of a closed-loop stimulation in the management of medically refractory focal epilepsy

A technical note

Kostas N. Fountas, Joseph R. Smith, Anthony M. Murro, Jeffrey Politsky, Yong D. Park, Patrick D. Jenkins

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

Open-loop stimulation studies have shown varying control of seizures with stimulation of different anatomical targets. A recent multi-institutional clinical study utilizing an external closed-loop stimulation system had promising results. A novel implantable closed-loop Responsive Neurostimulation System (RNS) (Neuropace, Inc., Mountainview, Calif., USA) consisting of a cranially implanted pulse generator, one or two quadripolar subdural strip or depth leads and a programmer is under testing in a prospective clinical trial. The RNS pulse generator continuously analyzes the patient's electrocortigrams (ECoGs) and automatically triggers electrical stimulation when specific ECoG characteristics programmed by the clinician, as indicative of electrographic seizures or precursor of epileptiform activities, are detected. The pulse generator then stores diagnostic information detailing detections and stimulations, including multichannel stored ECoGs. The RNS programmer communicates transcutaneously with the implanted pulse generator when initiated by a clinician. The RNS programmer can download diagnostics and store ECoGs for review. The RNS programmer can then be used to program detection and stimulation parameters. In our current communication, we describe the selection criteria for implanting this system, the preparation of the surgical candidates as well as the surgical technique. We also present our preliminary results with 8 patients who had an RNS implanted. Seven patients (87.5%) had more than 45% decrease in their seizure frequency. The mean follow-up time in our series was 9.2 months. The implantation of a closed-loop stimulation system, in our experience, represents a safe and relatively simple surgical procedure. However, the efficacy of this new treatment modality remains to be determined in further multi-institutional, prospective clinical studies.

Original languageEnglish (US)
Pages (from-to)153-158
Number of pages6
JournalStereotactic and Functional Neurosurgery
Volume83
Issue number4
DOIs
StatePublished - Dec 1 2005

Fingerprint

Partial Epilepsy
Seizures
Patient Selection
Electric Stimulation
Communication
Clinical Trials
Prospective Studies
Clinical Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Fountas, Kostas N. ; Smith, Joseph R. ; Murro, Anthony M. ; Politsky, Jeffrey ; Park, Yong D. ; Jenkins, Patrick D. / Implantation of a closed-loop stimulation in the management of medically refractory focal epilepsy : A technical note. In: Stereotactic and Functional Neurosurgery. 2005 ; Vol. 83, No. 4. pp. 153-158.
@article{62b28bf83d234ad8b919b1b6e15d690f,
title = "Implantation of a closed-loop stimulation in the management of medically refractory focal epilepsy: A technical note",
abstract = "Open-loop stimulation studies have shown varying control of seizures with stimulation of different anatomical targets. A recent multi-institutional clinical study utilizing an external closed-loop stimulation system had promising results. A novel implantable closed-loop Responsive Neurostimulation System (RNS) (Neuropace, Inc., Mountainview, Calif., USA) consisting of a cranially implanted pulse generator, one or two quadripolar subdural strip or depth leads and a programmer is under testing in a prospective clinical trial. The RNS pulse generator continuously analyzes the patient's electrocortigrams (ECoGs) and automatically triggers electrical stimulation when specific ECoG characteristics programmed by the clinician, as indicative of electrographic seizures or precursor of epileptiform activities, are detected. The pulse generator then stores diagnostic information detailing detections and stimulations, including multichannel stored ECoGs. The RNS programmer communicates transcutaneously with the implanted pulse generator when initiated by a clinician. The RNS programmer can download diagnostics and store ECoGs for review. The RNS programmer can then be used to program detection and stimulation parameters. In our current communication, we describe the selection criteria for implanting this system, the preparation of the surgical candidates as well as the surgical technique. We also present our preliminary results with 8 patients who had an RNS implanted. Seven patients (87.5{\%}) had more than 45{\%} decrease in their seizure frequency. The mean follow-up time in our series was 9.2 months. The implantation of a closed-loop stimulation system, in our experience, represents a safe and relatively simple surgical procedure. However, the efficacy of this new treatment modality remains to be determined in further multi-institutional, prospective clinical studies.",
author = "Fountas, {Kostas N.} and Smith, {Joseph R.} and Murro, {Anthony M.} and Jeffrey Politsky and Park, {Yong D.} and Jenkins, {Patrick D.}",
year = "2005",
month = "12",
day = "1",
doi = "10.1159/000088656",
language = "English (US)",
volume = "83",
pages = "153--158",
journal = "Stereotactic and Functional Neurosurgery",
issn = "1011-6125",
publisher = "S. Karger AG",
number = "4",

}

Implantation of a closed-loop stimulation in the management of medically refractory focal epilepsy : A technical note. / Fountas, Kostas N.; Smith, Joseph R.; Murro, Anthony M.; Politsky, Jeffrey; Park, Yong D.; Jenkins, Patrick D.

In: Stereotactic and Functional Neurosurgery, Vol. 83, No. 4, 01.12.2005, p. 153-158.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Implantation of a closed-loop stimulation in the management of medically refractory focal epilepsy

T2 - A technical note

AU - Fountas, Kostas N.

AU - Smith, Joseph R.

AU - Murro, Anthony M.

AU - Politsky, Jeffrey

AU - Park, Yong D.

AU - Jenkins, Patrick D.

PY - 2005/12/1

Y1 - 2005/12/1

N2 - Open-loop stimulation studies have shown varying control of seizures with stimulation of different anatomical targets. A recent multi-institutional clinical study utilizing an external closed-loop stimulation system had promising results. A novel implantable closed-loop Responsive Neurostimulation System (RNS) (Neuropace, Inc., Mountainview, Calif., USA) consisting of a cranially implanted pulse generator, one or two quadripolar subdural strip or depth leads and a programmer is under testing in a prospective clinical trial. The RNS pulse generator continuously analyzes the patient's electrocortigrams (ECoGs) and automatically triggers electrical stimulation when specific ECoG characteristics programmed by the clinician, as indicative of electrographic seizures or precursor of epileptiform activities, are detected. The pulse generator then stores diagnostic information detailing detections and stimulations, including multichannel stored ECoGs. The RNS programmer communicates transcutaneously with the implanted pulse generator when initiated by a clinician. The RNS programmer can download diagnostics and store ECoGs for review. The RNS programmer can then be used to program detection and stimulation parameters. In our current communication, we describe the selection criteria for implanting this system, the preparation of the surgical candidates as well as the surgical technique. We also present our preliminary results with 8 patients who had an RNS implanted. Seven patients (87.5%) had more than 45% decrease in their seizure frequency. The mean follow-up time in our series was 9.2 months. The implantation of a closed-loop stimulation system, in our experience, represents a safe and relatively simple surgical procedure. However, the efficacy of this new treatment modality remains to be determined in further multi-institutional, prospective clinical studies.

AB - Open-loop stimulation studies have shown varying control of seizures with stimulation of different anatomical targets. A recent multi-institutional clinical study utilizing an external closed-loop stimulation system had promising results. A novel implantable closed-loop Responsive Neurostimulation System (RNS) (Neuropace, Inc., Mountainview, Calif., USA) consisting of a cranially implanted pulse generator, one or two quadripolar subdural strip or depth leads and a programmer is under testing in a prospective clinical trial. The RNS pulse generator continuously analyzes the patient's electrocortigrams (ECoGs) and automatically triggers electrical stimulation when specific ECoG characteristics programmed by the clinician, as indicative of electrographic seizures or precursor of epileptiform activities, are detected. The pulse generator then stores diagnostic information detailing detections and stimulations, including multichannel stored ECoGs. The RNS programmer communicates transcutaneously with the implanted pulse generator when initiated by a clinician. The RNS programmer can download diagnostics and store ECoGs for review. The RNS programmer can then be used to program detection and stimulation parameters. In our current communication, we describe the selection criteria for implanting this system, the preparation of the surgical candidates as well as the surgical technique. We also present our preliminary results with 8 patients who had an RNS implanted. Seven patients (87.5%) had more than 45% decrease in their seizure frequency. The mean follow-up time in our series was 9.2 months. The implantation of a closed-loop stimulation system, in our experience, represents a safe and relatively simple surgical procedure. However, the efficacy of this new treatment modality remains to be determined in further multi-institutional, prospective clinical studies.

UR - http://www.scopus.com/inward/record.url?scp=29144536171&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=29144536171&partnerID=8YFLogxK

U2 - 10.1159/000088656

DO - 10.1159/000088656

M3 - Article

VL - 83

SP - 153

EP - 158

JO - Stereotactic and Functional Neurosurgery

JF - Stereotactic and Functional Neurosurgery

SN - 1011-6125

IS - 4

ER -