TY - JOUR
T1 - The Best Things Happen When You Least Expect Them
T2 - Responsive Neurostimulation During Low-Risk Brain States is Associated with Improved Long-Term Seizure Suppression
AU - Philipsberg, Paul A.
AU - Shuman, Tristan
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/9/1
Y1 - 2024/9/1
N2 - Closed-Loop Stimulation in Periods With Less Epileptiform Activity Drives Improved Epilepsy Outcomes Anderson DN, Charlebois CM, Smith EH, Davis TS, Peters AY, Newman BJ, Arain AM, Wilcox KS, Butson CR, Rolston JD. Brain. 2024;147(2):521-531. doi:10.1093/brain/awad343. PMID: 37796038; PMCID: PMC10834245 In patients with drug-resistant epilepsy, electrical stimulation of the brain in response to epileptiform activity can make seizures less frequent and debilitating. This therapy, known as closed-loop responsive neurostimulation (RNS), aims to directly halt seizure activity via targeted stimulation of a burgeoning seizure. Rather than immediately stopping seizures as they start, many RNS implants produce slower, long-lasting changes in brain dynamics that better predict clinical outcomes. Here we hypothesize that stimulation during brain states with less epileptiform activity drives long-term changes that restore healthy brain networks. To test this, we quantified stimulation episodes during low- and high-risk brain states, that is, stimulation during periods with a lower or higher risk of generating epileptiform activity in a cohort of 40 patients treated with RNS. More frequent stimulation in tonic low-risk states, and out of rhythmic high-risk states, predicted seizure reduction. Additionally, stimulation events were more likely to be phase-locked to prolonged episodes of abnormal activity for intermediate and poor responders when compared to super responders, consistent with the hypothesis that improved outcomes are driven by stimulation during low-risk states. These results support the hypothesis that stimulation during low-risk periods might underlie the mechanisms of RNS, suggesting a relationship between temporal patterns of neuromodulation and plasticity that facilitates long-term seizure reduction.
AB - Closed-Loop Stimulation in Periods With Less Epileptiform Activity Drives Improved Epilepsy Outcomes Anderson DN, Charlebois CM, Smith EH, Davis TS, Peters AY, Newman BJ, Arain AM, Wilcox KS, Butson CR, Rolston JD. Brain. 2024;147(2):521-531. doi:10.1093/brain/awad343. PMID: 37796038; PMCID: PMC10834245 In patients with drug-resistant epilepsy, electrical stimulation of the brain in response to epileptiform activity can make seizures less frequent and debilitating. This therapy, known as closed-loop responsive neurostimulation (RNS), aims to directly halt seizure activity via targeted stimulation of a burgeoning seizure. Rather than immediately stopping seizures as they start, many RNS implants produce slower, long-lasting changes in brain dynamics that better predict clinical outcomes. Here we hypothesize that stimulation during brain states with less epileptiform activity drives long-term changes that restore healthy brain networks. To test this, we quantified stimulation episodes during low- and high-risk brain states, that is, stimulation during periods with a lower or higher risk of generating epileptiform activity in a cohort of 40 patients treated with RNS. More frequent stimulation in tonic low-risk states, and out of rhythmic high-risk states, predicted seizure reduction. Additionally, stimulation events were more likely to be phase-locked to prolonged episodes of abnormal activity for intermediate and poor responders when compared to super responders, consistent with the hypothesis that improved outcomes are driven by stimulation during low-risk states. These results support the hypothesis that stimulation during low-risk periods might underlie the mechanisms of RNS, suggesting a relationship between temporal patterns of neuromodulation and plasticity that facilitates long-term seizure reduction.
UR - http://www.scopus.com/inward/record.url?scp=85196214868&partnerID=8YFLogxK
U2 - 10.1177/15357597241258287
DO - 10.1177/15357597241258287
M3 - Comment/debate
AN - SCOPUS:85196214868
SN - 1535-7597
VL - 24
SP - 350
EP - 352
JO - Epilepsy Currents
JF - Epilepsy Currents
IS - 5
ER -