TY - JOUR
T1 - Long-term outcomes after responsive neurostimulation for treatment of refractory epilepsy
T2 - a single-center experience of 100 cases
AU - Roa, Jorge A.
AU - Marcuse, Lara
AU - Fields, Madeline
AU - Vega-Talbott, Maite La
AU - Yoo, Ji Yeoun
AU - Wolf, Steven M.
AU - McGoldrick, Patricia
AU - Ghatan, Saadi
AU - Panov, Fedor
N1 - Publisher Copyright:
©AANS 2023, except where prohibited by US copyright law.
PY - 2023
Y1 - 2023
N2 - OBJECTIVE Despite antiepileptic drugs, more than 30% of people with epilepsy continue to have seizures. Patients with such drug-resistant epilepsy (DRE) may undergo invasive treatment such as resection, laser ablation of the epileptogenic focus, or vagus nerve stimulation, but many are not candidates for epilepsy surgery or fail to respond to such interventions. Responsive neurostimulation (RNS) provides a neuromodulatory option. In this study, the authors present a single-center experience with the use of RNS over the last 5 years to provide long-term control of seizures in patients with DRE with at least 1 year of follow-up. METHODS The authors performed a retrospective analysis of a prospectively collected single-center database of consecutive DRE patients who underwent RNS system implantation from September 2015 to December 2020. Patients were followed-up postoperatively to evaluate seizure freedom and complications. RESULTS One hundred patients underwent RNS placement. Seven patients developed infections: 2 responded to intravenous antibiotic therapy, 3 required partial removal and salvaging of the system, and 2 required complete removal of the RNS device. No postoperative tract hemorrhages, strokes, device migrations, or malfunctions were documented in this cohort. The average follow-up period was 26.3 months (range 1–5.2 years). In terms of seizure reduction, 8 patients had 0%–24% improvement, 14 had 25%–49% improvement, 29 experienced 50%–74% improvement, 30 had 75%–99% improvement, and 19 achieved seizure freedom. RNS showed significantly better outcomes over time: patients with more than 3 years of RNS therapy had 1.8 higher odds of achieving 75% or more seizure reduction (95% CI 1.07–3.09, p = 0.02). Also, patients who had undergone resective or ablative surgery prior to RNS implantation had 8.25 higher odds of experiencing 50% or more seizure reduction (95% CI 1.05–65.1, p = 0.04). CONCLUSIONS Responsive neurostimulator implantation achieved 50% or more seizure reduction in approximately 80% of patients. Even in patients who did not achieve seizure freedom, significant improvement in seizure duration, severity, or postictal state was reported in more than 68% of cases. Infection (7%) was the most common complication. Patients with prior resective or ablative procedures and those who had been treated with RNS for more than 3 years achieved better outcomes.
AB - OBJECTIVE Despite antiepileptic drugs, more than 30% of people with epilepsy continue to have seizures. Patients with such drug-resistant epilepsy (DRE) may undergo invasive treatment such as resection, laser ablation of the epileptogenic focus, or vagus nerve stimulation, but many are not candidates for epilepsy surgery or fail to respond to such interventions. Responsive neurostimulation (RNS) provides a neuromodulatory option. In this study, the authors present a single-center experience with the use of RNS over the last 5 years to provide long-term control of seizures in patients with DRE with at least 1 year of follow-up. METHODS The authors performed a retrospective analysis of a prospectively collected single-center database of consecutive DRE patients who underwent RNS system implantation from September 2015 to December 2020. Patients were followed-up postoperatively to evaluate seizure freedom and complications. RESULTS One hundred patients underwent RNS placement. Seven patients developed infections: 2 responded to intravenous antibiotic therapy, 3 required partial removal and salvaging of the system, and 2 required complete removal of the RNS device. No postoperative tract hemorrhages, strokes, device migrations, or malfunctions were documented in this cohort. The average follow-up period was 26.3 months (range 1–5.2 years). In terms of seizure reduction, 8 patients had 0%–24% improvement, 14 had 25%–49% improvement, 29 experienced 50%–74% improvement, 30 had 75%–99% improvement, and 19 achieved seizure freedom. RNS showed significantly better outcomes over time: patients with more than 3 years of RNS therapy had 1.8 higher odds of achieving 75% or more seizure reduction (95% CI 1.07–3.09, p = 0.02). Also, patients who had undergone resective or ablative surgery prior to RNS implantation had 8.25 higher odds of experiencing 50% or more seizure reduction (95% CI 1.05–65.1, p = 0.04). CONCLUSIONS Responsive neurostimulator implantation achieved 50% or more seizure reduction in approximately 80% of patients. Even in patients who did not achieve seizure freedom, significant improvement in seizure duration, severity, or postictal state was reported in more than 68% of cases. Infection (7%) was the most common complication. Patients with prior resective or ablative procedures and those who had been treated with RNS for more than 3 years achieved better outcomes.
KW - complications
KW - epilepsy
KW - outcome
KW - predictor
KW - refractory
KW - responsive neurostimulation
UR - http://www.scopus.com/inward/record.url?scp=85176496365&partnerID=8YFLogxK
U2 - 10.3171/2023.2.JNS222116
DO - 10.3171/2023.2.JNS222116
M3 - Article
C2 - 37655833
AN - SCOPUS:85176496365
SN - 0022-3085
VL - 139
SP - 1463
EP - 1470
JO - Journal of Neurosurgery
JF - Journal of Neurosurgery
IS - 5
ER -