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Lim SN, Lee CY, Lee ST, Tu PH, Chang BL, Lee CH, Cheng MY, Chang CW, Tseng WEJ, Hsieh HY, Chiang HI, Wu T. Low and High Frequency Hippocampal Stimulation for Drug-Resistant Mesial Temporal Lobe Epilepsy. Neuromodulation 2016; 19:365-72. [PMID: 27072376 PMCID: PMC5074270 DOI: 10.1111/ner.12435] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/23/2015] [Accepted: 02/28/2016] [Indexed: 11/26/2022]
Abstract
Objective Electrical stimulation of the hippocampus offers the possibility to treat patients with mesial temporal lobe epilepsy (MTLE) who are not surgical candidates. We report long‐term follow‐up results in five patients receiving low or high frequency hippocampal stimulation for drug‐resistant MTLE. Materials and Methods The patients underwent stereotactic implantation of quadripolar stimulating electrodes in the hippocampus. Two of the patients received unilateral electrode implantation, while the other three received bilateral implantation. Stimulation of the hippocampal electrodes was turned ON immediately after the implantation of an implantable pulse generator, with initial stimulation parameters: 1 V, 90–150 μs, 5 or 145 Hz. The frequency of seizures was monitored and compared with preimplantation baseline data. Results Two men and three women, aged 27–61 years were studied, with a mean follow‐up period of 38.4 months (range, 30–42 months). The baseline seizure frequency was 2.0–15.3/month. The five patients had an average 45% (range 22–72%) reduction in the frequency of seizures after hippocampal stimulation over the study period. Low frequency hippocampal stimulation decreased the frequency of seizures in two patients (by 54% and 72%, respectively). No implantation‐ or stimulation‐related side effects were reported. Conclusions Electrical stimulation of the hippocampus is a minimally invasive and reversible method that can improve seizure outcomes in patients with drug‐resistant MTLE. The optimal frequency of stimulation varied from patient to patient and therefore required individual setting. These experimental results warrant further controlled studies with a large patient population to evaluate the long‐term effect of hippocampal stimulation with different stimulation parameters.
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Affiliation(s)
- Siew-Na Lim
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Bao-Luen Chang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hong Lee
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-En Johnny Tseng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiang-Yao Hsieh
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
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353
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Pevzner A, Izadi A, Lee DJ, Shahlaie K, Gurkoff GG. Making Waves in the Brain: What Are Oscillations, and Why Modulating Them Makes Sense for Brain Injury. Front Syst Neurosci 2016; 10:30. [PMID: 27092062 PMCID: PMC4823270 DOI: 10.3389/fnsys.2016.00030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/22/2016] [Indexed: 01/19/2023] Open
Abstract
Traumatic brain injury (TBI) can result in persistent cognitive, behavioral and emotional deficits. However, the vast majority of patients are not chronically hospitalized; rather they have to manage their disabilities once they are discharged to home. Promoting recovery to pre-injury level is important from a patient care as well as a societal perspective. Electrical neuromodulation is one approach that has shown promise in alleviating symptoms associated with neurological disorders such as in Parkinson’s disease (PD) and epilepsy. Consistent with this perspective, both animal and clinical studies have revealed that TBI alters physiological oscillatory rhythms. More recently several studies demonstrated that low frequency stimulation improves cognitive outcome in models of TBI. Specifically, stimulation of the septohippocampal circuit in the theta frequency entrained oscillations and improved spatial learning following TBI. In order to evaluate the potential of electrical deep brain stimulation for clinical translation we review the basic neurophysiology of oscillations, their role in cognition and how they are changed post-TBI. Furthermore, we highlight several factors for future pre-clinical and clinical studies to consider, with the hope that it will promote a hypothesis driven approach to subsequent experimental designs and ultimately successful translation to improve outcome in patients with TBI.
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Affiliation(s)
- Aleksandr Pevzner
- Department of Neurological Surgery, University of California-DavisSacramento, CA, USA; Center for Neuroscience, University of California-DavisSacramento, CA, USA
| | - Ali Izadi
- Department of Neurological Surgery, University of California-DavisSacramento, CA, USA; Center for Neuroscience, University of California-DavisSacramento, CA, USA
| | - Darrin J Lee
- Department of Neurological Surgery, University of California-DavisSacramento, CA, USA; Center for Neuroscience, University of California-DavisSacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California-DavisSacramento, CA, USA; Center for Neuroscience, University of California-DavisSacramento, CA, USA
| | - Gene G Gurkoff
- Department of Neurological Surgery, University of California-DavisSacramento, CA, USA; Center for Neuroscience, University of California-DavisSacramento, CA, USA
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354
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Hammer DX, Lozzi A, Boretsky A, Welle CG. Acute insertion effects of penetrating cortical microelectrodes imaged with quantitative optical coherence angiography. NEUROPHOTONICS 2016; 3:025002. [PMID: 32064297 PMCID: PMC7011942 DOI: 10.1117/1.nph.3.2.025002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/16/2016] [Indexed: 05/16/2023]
Abstract
The vascular response during cortical microelectrode insertion was measured with amplitude decorrelation-based quantitative optical coherence angiography (OCA). Four different shank-style microelectrode configurations were inserted in murine motor cortex beneath a surgically implanted window in discrete steps while OCA images were collected and processed for angiography and flowmetry. Quantitative measurements included tissue displacement (measured by optical flow), perfused capillary density, and capillary flow velocity. The primary effect of insertion was mechanical perturbation, the effects of which included tissue displacement, arteriolar rupture, and compression of a branch of the anterior cerebral artery causing a global decrease in flow. Other effects observed included local flow drop-out in the region immediately surrounding the microelectrode. The mean basal capillary network velocity for all animals was 0.23 ( ± 0.05 SD ) and 0.18 ( ± 0.07 SD ) mm / s for capillaries from 100 to 300 μ m and 300 to 500 μ m , respectively. Upon insertion, the 2-shank electrode arrays caused a decrease in capillary flow density and velocity, while the results from other configurations were not different from controls. The proximity to large vessels appears to play a larger role than the array configuration. These results can guide neurosurgeons and electrode designers to minimize trauma and ischemia during microelectrode insertion.
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Affiliation(s)
- Daniel X. Hammer
- Center for Devices and Radiological Health, Food and Drug Administration, Division of Biomedical Physics, Office of Science and Engineering Laboratories, 20903 New Hampshire Avenue, Silver Spring, Maryland 20993, United States
- Address all correspondence to: Daniel X. Hammer, E-mail:
| | - Andrea Lozzi
- Center for Devices and Radiological Health, Food and Drug Administration, Division of Biomedical Physics, Office of Science and Engineering Laboratories, 20903 New Hampshire Avenue, Silver Spring, Maryland 20993, United States
| | - Adam Boretsky
- Center for Devices and Radiological Health, Food and Drug Administration, Division of Biomedical Physics, Office of Science and Engineering Laboratories, 20903 New Hampshire Avenue, Silver Spring, Maryland 20993, United States
| | - Cristin G. Welle
- Center for Devices and Radiological Health, Food and Drug Administration, Division of Biomedical Physics, Office of Science and Engineering Laboratories, 20903 New Hampshire Avenue, Silver Spring, Maryland 20993, United States
- University of Colorado Denver, Departments of Neurosurgery and Bioengineering, 12700 East 19th Avenue, Aurora, Colorado 80045, United States
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355
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Abstract
In the approximately 1% of children affected by epilepsy, pharmacoresistance and early age of seizure onset are strongly correlated with poor cognitive outcomes, depression, anxiety, developmental delay, and impaired activities of daily living. These children often require multiple surgical procedures, including invasive diagnostic procedures with intracranial electrodes to identify the seizure-onset zone. The recent development of minimally invasive surgical techniques, including stereotactic electroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT), and new applications of neurostimulation, such as responsive neurostimulation (RNS), are quickly changing the landscape of the surgical management of pediatric epilepsy. In this review, the authors discuss these various technologies, their current applications, and limitations in the treatment of pediatric drug-resistant epilepsy, as well as areas for future research. The development of minimally invasive diagnostic and ablative surgical techniques together with new paradigms in neurostimulation hold vast potential to improve the efficacy and reduce the morbidity of the surgical management of children with drug-resistant epilepsy.
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Affiliation(s)
- Michael Karsy
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Jian Guan
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Katrina Ducis
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Robert J Bollo
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
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356
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Klooster DCW, de Louw AJA, Aldenkamp AP, Besseling RMH, Mestrom RMC, Carrette S, Zinger S, Bergmans JWM, Mess WH, Vonck K, Carrette E, Breuer LEM, Bernas A, Tijhuis AG, Boon P. Technical aspects of neurostimulation: Focus on equipment, electric field modeling, and stimulation protocols. Neurosci Biobehav Rev 2016; 65:113-41. [PMID: 27021215 DOI: 10.1016/j.neubiorev.2016.02.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/05/2016] [Accepted: 02/17/2016] [Indexed: 12/31/2022]
Abstract
Neuromodulation is a field of science, medicine, and bioengineering that encompasses implantable and non-implantable technologies for the purpose of improving quality of life and functioning of humans. Brain neuromodulation involves different neurostimulation techniques: transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), which are being used both to study their effects on cognitive brain functions and to treat neuropsychiatric disorders. The mechanisms of action of neurostimulation remain incompletely understood. Insight into the technical basis of neurostimulation might be a first step towards a more profound understanding of these mechanisms, which might lead to improved clinical outcome and therapeutic potential. This review provides an overview of the technical basis of neurostimulation focusing on the equipment, the present understanding of induced electric fields, and the stimulation protocols. The review is written from a technical perspective aimed at supporting the use of neurostimulation in clinical practice.
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Affiliation(s)
- D C W Klooster
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - A J A de Louw
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - A P Aldenkamp
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - R M H Besseling
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - R M C Mestrom
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - S Carrette
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - S Zinger
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - J W M Bergmans
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - W H Mess
- Departments of Clinical Neurophysiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - K Vonck
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - E Carrette
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - L E M Breuer
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands.
| | - A Bernas
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - A G Tijhuis
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - P Boon
- Kempenhaeghe Academic Center for Epileptology, P.O. Box 61, 5590 AB Heeze, The Netherlands; Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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357
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Ng KA, Greenwald E, Xu YP, Thakor NV. Implantable neurotechnologies: a review of integrated circuit neural amplifiers. Med Biol Eng Comput 2016; 54:45-62. [PMID: 26798055 DOI: 10.1007/s11517-015-1431-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 12/11/2015] [Indexed: 11/24/2022]
Abstract
Neural signal recording is critical in modern day neuroscience research and emerging neural prosthesis programs. Neural recording requires the use of precise, low-noise amplifier systems to acquire and condition the weak neural signals that are transduced through electrode interfaces. Neural amplifiers and amplifier-based systems are available commercially or can be designed in-house and fabricated using integrated circuit (IC) technologies, resulting in very large-scale integration or application-specific integrated circuit solutions. IC-based neural amplifiers are now used to acquire untethered/portable neural recordings, as they meet the requirements of a miniaturized form factor, light weight and low power consumption. Furthermore, such miniaturized and low-power IC neural amplifiers are now being used in emerging implantable neural prosthesis technologies. This review focuses on neural amplifier-based devices and is presented in two interrelated parts. First, neural signal recording is reviewed, and practical challenges are highlighted. Current amplifier designs with increased functionality and performance and without penalties in chip size and power are featured. Second, applications of IC-based neural amplifiers in basic science experiments (e.g., cortical studies using animal models), neural prostheses (e.g., brain/nerve machine interfaces) and treatment of neuronal diseases (e.g., DBS for treatment of epilepsy) are highlighted. The review concludes with future outlooks of this technology and important challenges with regard to neural signal amplification.
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Affiliation(s)
- Kian Ann Ng
- Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, Singapore, 117456, Singapore. .,Department of Electrical and Computer Engineering, National University of Singapore, Singapore, 117576, Singapore.
| | - Elliot Greenwald
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Yong Ping Xu
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, 117576, Singapore
| | - Nitish V Thakor
- Singapore Institute for Neurotechnology (SINAPSE), National University of Singapore, Singapore, 117456, Singapore.,Department of Electrical and Computer Engineering, National University of Singapore, Singapore, 117576, Singapore.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
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358
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Krishna V, King NKK, Sammartino F, Strauss I, Andrade DM, Wennberg RA, Lozano AM. Anterior Nucleus Deep Brain Stimulation for Refractory Epilepsy. Neurosurgery 2016; 78:802-11. [DOI: 10.1227/neu.0000000000001197] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Abstract
BACKGROUND:
Anterior nucleus (AN) deep brain stimulation (DBS) is a palliative treatment for medically refractory epilepsy. The long-term efficacy and the optimal target localization for AN DBS are not well understood.
OBJECTIVE:
To analyze the long-term efficacy of AN DBS and its predictors.
METHODS:
We performed a retrospective review of 16 patients who underwent AN DBS. We selected only patients with reliable seizure frequency data and at least a 1-year follow-up. We studied the duration of the seizure reduction after DBS insertion and before stimulation (the insertional effect) and its association with long-term outcome. We modeled the volume of activation using the active contacts, stimulation parameters, and postoperative imaging. The overlap of this volume was plotted in Montreal Neurological Institute 152 space in 7 patients with significant clinical efficacy.
RESULTS:
Nine patients reported a decrease in seizure frequency immediately after electrode insertion (insertional or microthalamotomy effect). The duration of insertional effect varied from 2 to 4 months. However, 1 patient had a long-term insertional effect of 36 months. Altogether, 11 patients reported >50% decrease in seizure frequency with long-term stimulation. The most common pattern of seizure control was immediate and sustained stimulation benefit (n = 8). In patients with long-term stimulation benefit, the efficacious target was localized in the anteroventral AN in close proximity to the mammillothalamic tract.
CONCLUSION:
AN DBS is efficacious in the control of seizure frequency in selected patients. An insertional effect is commonly observed (56%). The most efficacious site of stimulation appears to be the anteroventral AN.
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Affiliation(s)
| | | | | | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Danielle M. Andrade
- Department of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Richard A. Wennberg
- Department of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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359
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Klinger NV, Mittal S. Clinical efficacy of deep brain stimulation for the treatment of medically refractory epilepsy. Clin Neurol Neurosurg 2016; 140:11-25. [DOI: 10.1016/j.clineuro.2015.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 10/26/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
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360
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Wei Z, Gordon CR, Bergey GK, Sacks JM, Anderson WS. Implant Site Infection and Bone Flap Osteomyelitis Associated with the NeuroPace Responsive Neurostimulation System. World Neurosurg 2015; 88:687.e1-687.e6. [PMID: 26743382 DOI: 10.1016/j.wneu.2015.11.106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/08/2015] [Accepted: 11/12/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The NeuroPace RNS System is a method recently approved by the U.S. Food and Drug Administration for closed-loop direct brain stimulation in selected patients with drug-resistant partial seizures. The long-term risks of implant site infection and accompanying bone flap osteomyelitis associated with responsive neurostimulation (RNS) devices have not been fully appreciated. CASE DESCRIPTION We report 3 cases of refractory partial epilepsy that were treated with RNS therapy in conjunction with antiepileptic drugs. Patients underwent invasive epilepsy monitoring and resection of seizure foci. All patients continued to have debilitating partial seizures and underwent implantation of the RNS device, which resulted in various degrees of symptomatic relief. On average, the battery of the implantable pulse generator was replaced every 2 years. All 3 patients developed implant site infection and bone flap osteomyelitis with multiple implantable pulse generator replacements, and the RNS devices were removed. Bone flaps were removed in 2 patients because of significant osteomyelitis and were reconstructed in a delayed fashion with customized cranial implants. No patient had evidence of meningitis or cerebritis. The patients were treated via a multidisciplinary approach, and all patients recovered well with satisfactory wound healing and seizure control. CONCLUSIONS Implant site infection and bone flap osteomyelitis are significant adverse events associated with the RNS device. The incidence of infection in this series (10%) is comparable to the incidence reported in the long-term trial. The infection risk is mainly associated with reoperations and increases with multiple implantable pulse generator replacements. The RNS device may benefit from reducing technical risk factors that are associated with postoperative bone and soft tissue infections.
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Affiliation(s)
- Zhikui Wei
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - Chad R Gordon
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gregory K Bergey
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Justin M Sacks
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - William S Anderson
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
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361
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Making sense: Determining the parameter space of electrical brain stimulation. Proc Natl Acad Sci U S A 2015; 112:15012-3. [PMID: 26607448 DOI: 10.1073/pnas.1520704112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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362
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Miller KJ, Burns TC, Grant GA, Halpern CH. Responsive stimulation of motor cortex for medically and surgically refractive epilepsy. Seizure 2015; 33:38-40. [DOI: 10.1016/j.seizure.2015.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/17/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022] Open
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363
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Kros L, Eelkman Rooda OHJ, De Zeeuw CI, Hoebeek FE. Controlling Cerebellar Output to Treat Refractory Epilepsy. Trends Neurosci 2015; 38:787-799. [PMID: 26602765 DOI: 10.1016/j.tins.2015.10.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/12/2015] [Accepted: 10/18/2015] [Indexed: 11/27/2022]
Abstract
Generalized epilepsy is characterized by recurrent seizures caused by oscillatory neuronal firing throughout thalamocortical networks. Current therapeutic approaches often intervene at the level of the thalamus or cerebral cortex to ameliorate seizures. We review here the therapeutic potential of cerebellar stimulation. The cerebellum forms a prominent ascending input to the thalamus and, whereas stimulation of the foliated cerebellar cortex exerts inconsistent results, stimulation of the centrally located cerebellar nuclei (CN) reliably stops generalized seizures in experimental models. Stimulation of this area indicates that the period of stimulation with respect to the phase of the oscillations in thalamocortical networks can optimize its effect, opening up the possibility of developing on-demand deep brain stimulation (DBS) treatments.
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Affiliation(s)
- Lieke Kros
- Department of Neuroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Oscar H J Eelkman Rooda
- Department of Neuroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Chris I De Zeeuw
- Department of Neuroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands; Netherlands Institute for Neuroscience, Royal Dutch Academy for Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands
| | - Freek E Hoebeek
- Department of Neuroscience, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
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364
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Abstract
Various neurostimulation modalities have emerged in the field of epilepsy. Despite the fact that delivery of an electrical current to the hyperexcitable epileptic brain might, at first, seem contradictory, neurostimulation has become an established therapeutic option with a promising efficacy and adverse effects profile. In "responsive" neurostimulation the strategy is to interfere as early as possible with the accumulation of seizure activity to prematurely abort or even prevent an upcoming seizure. The design of technology required for responsive stimulation is more challenging compared with devices for open-loop neurostimulation. The achievement of therapeutic success is dependent on adequate sensing and stimulation algorithms and a fast coupling between both. The benefits of delivering current only at the time of an approaching seizure merit further investigation. Current experience with responsive neurostimulation in epilepsy is still limited, but seems promising.
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Affiliation(s)
- Sofie Carrette
- a Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University, Department of Neurology , Ghent University Hospital, Institute for Neuroscience , Ghent , Belgium
| | - Paul Boon
- a Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University, Department of Neurology , Ghent University Hospital, Institute for Neuroscience , Ghent , Belgium
| | - Mathieu Sprengers
- a Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University, Department of Neurology , Ghent University Hospital, Institute for Neuroscience , Ghent , Belgium
| | - Robrecht Raedt
- a Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University, Department of Neurology , Ghent University Hospital, Institute for Neuroscience , Ghent , Belgium
| | - Kristl Vonck
- a Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University, Department of Neurology , Ghent University Hospital, Institute for Neuroscience , Ghent , Belgium
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365
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Löscher W, Hirsch LJ, Schmidt D. The enigma of the latent period in the development of symptomatic acquired epilepsy - Traditional view versus new concepts. Epilepsy Behav 2015; 52:78-92. [PMID: 26409135 DOI: 10.1016/j.yebeh.2015.08.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 08/30/2015] [Indexed: 01/21/2023]
Abstract
A widely accepted hypothesis holds that there is a seizure-free, pre-epileptic state, termed the "latent period", between a brain insult, such as traumatic brain injury or stroke, and the onset of symptomatic epilepsy, during which a cascade of structural, molecular, and functional alterations gradually mediates the process of epileptogenesis. This review, based on recent data from both animal models and patients with different types of brain injury, proposes that epileptogenesis and often subclinical epilepsy can start immediately after brain injury without any appreciable latent period. Even though the latent period has traditionally been the cornerstone concept representing epileptogenesis, we suggest that the evidence for the existence of a latent period is spotty both for animal models and human epilepsy. Knowing whether a latent period exists or not is important for our understanding of epileptogenesis and for the discovery and the trial design of antiepileptogenic agents. The development of antiepileptogenic treatments to prevent epilepsy in patients at risk from a brain insult is a major unmet clinical need.
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Affiliation(s)
- Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, 30559 Hannover, Germany; Center for Systems Neuroscience, 30559 Hannover, Germany.
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366
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Herrington TM, Cheng JJ, Eskandar EN. Mechanisms of deep brain stimulation. J Neurophysiol 2015; 115:19-38. [PMID: 26510756 DOI: 10.1152/jn.00281.2015] [Citation(s) in RCA: 289] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/22/2015] [Indexed: 12/31/2022] Open
Abstract
Deep brain stimulation (DBS) is widely used for the treatment of movement disorders including Parkinson's disease, essential tremor, and dystonia and, to a lesser extent, certain treatment-resistant neuropsychiatric disorders including obsessive-compulsive disorder. Rather than a single unifying mechanism, DBS likely acts via several, nonexclusive mechanisms including local and network-wide electrical and neurochemical effects of stimulation, modulation of oscillatory activity, synaptic plasticity, and, potentially, neuroprotection and neurogenesis. These different mechanisms vary in importance depending on the condition being treated and the target being stimulated. Here we review each of these in turn and illustrate how an understanding of these mechanisms is inspiring next-generation approaches to DBS.
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Affiliation(s)
- Todd M Herrington
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Jennifer J Cheng
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Emad N Eskandar
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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367
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Abstract
Several palliative neuromodulation treatment modalities are currently available for adjunctive use in the treatment of medically intractable epilepsy. Over the past decades, a variety of different central and peripheral nervous system sites have been identified, clinically and experimentally, as potential targets for chronic, nonresponsive therapeutic neurostimulation. Currently, the main modalities in clinical use, from most invasive to least invasive, are anterior thalamus deep brain stimulation, vagus nerve stimulation, and trigeminal nerve stimulation. Significant reductions in seizure frequency have been demonstrated in clinical trials using each of these neuromodulation therapies.
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Affiliation(s)
- Vibhor Krishna
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T2S8, Canada
| | - Francesco Sammartino
- Division of Neurosurgery, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T2S8, Canada
| | - Nicholas Kon Kam King
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Rosa Qui Yue So
- Department of Neural & Biomedical Technology, Institute for Infocomm Research, Agency for Science, Technology and Research, 1 Fusionopolis Way, #21-01 Connexis, Singapore 138632
| | - Richard Wennberg
- Division of Neurology, University of Toronto, Krembil Neuroscience Centre, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T2S8, Canada.
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368
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Thomas GP, Jobst BC. Critical review of the responsive neurostimulator system for epilepsy. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:405-11. [PMID: 26491376 PMCID: PMC4598207 DOI: 10.2147/mder.s62853] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Patients with medically refractory epilepsy have historically had few effective treatment options. Electrical brain stimulation for seizures has been studied for decades and ongoing technological refinements have made possible the development of an implantable electrical brain stimulator. The NeuroPace responsive neurostimulator was recently approved by the FDA for clinical use and the initial reports are encouraging. This device continually monitors brain activity and delivers an electric stimulus when abnormal activity is detected. Early reports of efficacy suggest that the device is well tolerated and offers a reduction in seizure frequency by approximately half at 2 years.
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Affiliation(s)
- George P Thomas
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Barbara C Jobst
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
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369
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Bikson M, Truong DQ, Mourdoukoutas AP, Aboseria M, Khadka N, Adair D, Rahman A. Modeling sequence and quasi-uniform assumption in computational neurostimulation. PROGRESS IN BRAIN RESEARCH 2015; 222:1-23. [PMID: 26541374 DOI: 10.1016/bs.pbr.2015.08.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Computational neurostimulation aims to develop mathematical constructs that link the application of neuromodulation with changes in behavior and cognition. This process is critical but daunting for technical challenges and scientific unknowns. The overarching goal of this review is to address how this complex task can be made tractable. We describe a framework of sequential modeling steps to achieve this: (1) current flow models, (2) cell polarization models, (3) network and information processing models, and (4) models of the neuroscientific correlates of behavior. Each step is explained with a specific emphasis on the assumptions underpinning underlying sequential implementation. We explain the further implementation of the quasi-uniform assumption to overcome technical limitations and unknowns. We specifically focus on examples in electrical stimulation, such as transcranial direct current stimulation. Our approach and conclusions are broadly applied to immediate and ongoing efforts to deploy computational neurostimulation.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA.
| | - Dennis Q Truong
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | | | - Mohamed Aboseria
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Niranjan Khadka
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Devin Adair
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
| | - Asif Rahman
- Department of Biomedical Engineering, The City College of New York, CUNY, New York, NY, USA
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370
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Loring DW, Kapur R, Meador KJ, Morrell MJ. Differential neuropsychological outcomes following targeted responsive neurostimulation for partial-onset epilepsy. Epilepsia 2015; 56:1836-44. [PMID: 26385758 DOI: 10.1111/epi.13191] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Responsive neurostimulation decreases the frequency of disabling seizures when used as an adjunctive therapy in patients with medically refractory partial-onset seizures. The effect of long-term responsive neurostimulation on neuropsychological performance has not yet been established. METHODS Neuropsychological data were collected from subjects participating in the open-label arm of a randomized controlled trial of responsive neurostimulation with the RNS(®) System. Primary cognitive outcomes were the Boston Naming Test (BNT) and Rey Auditory Verbal Learning (AVLT) test. Neuropsychological performance was evaluated at baseline and again following 1 and 2 years of RNS System treatment. Follow-up analyses were conducted in patients with seizure onset restricted to either the mesial temporal lobe or neocortex. RESULTS No significant cognitive declines were observed for any neuropsychological measure through 2 years. When examined as a function of seizure onset region, a double dissociation was found, with significant improvement in naming across all patients (p < 0.0001), and for patients with neocortical seizure onsets (p < 0.0001) but not in patients with mesial temporal lobe (MTL) seizure onsets (p = 0.679). In contrast, a significant improvement in verbal learning was observed across all patients (p = 0.03), and for patients with MTL seizure onsets (p = 0.005) but not for patients with neocortical onsets (p = 0.403). SIGNIFICANCE Treatment with the RNS System is not associated with cognitive decline when tested through 2 years. In fact, there were small but significant beneficial treatment effects on naming in patients with neocortical onsets and modest improvements in verbal learning for patients with seizure onsets in MTL structures. These results suggest that there are modest cognitive improvements in some domains that vary as a function of the region from which seizures arise.
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Affiliation(s)
- David W Loring
- Departments of Neurology and Pediatrics, Emory University, Atlanta, Georgia, U.S.A
| | - Ritu Kapur
- Clinical Research, NeuroPace, Inc., Mountain View, California, U.S.A
| | - Kimford J Meador
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, California, U.S.A
| | - Martha J Morrell
- Clinical Research, NeuroPace, Inc., Mountain View, California, U.S.A.,Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, California, U.S.A
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371
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Between the Pulse Generator and the Anterior Thalamic Nucleus: The Light at the End of the Tunnel. Epilepsy Curr 2015; 15:183-4. [PMID: 26316862 DOI: 10.5698/1535-7511-15.4.183] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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372
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Abstract
OPINION STATEMENT Neuromodulation devices are used in the treatment of medically refractory epilepsy. This has been defined as epilepsy with persistent seizures despite adequate trials of at least two anti-epileptic drugs (AEDs). In most cases of medically refractory partial epilepsy, the first choice of treatment is resective surgery if the seizure focus can be definitively localized and if surgery can be safely performed without causing intolerable neurologic deficits. Patients with medically refractory epilepsy who are not candidates for potentially curative surgery may benefit from the implantation of a neuromodulation device. While most of these devices require surgical implantation, they provide a significant added seizure reduction without typical medication side effects. Furthermore, the efficacy of these devices continues to improve over years. There are currently no head-to-head trials comparing the different neuromodulation devices but efficacy appears to be roughly similar. The choice of device therefore depends on the type of epilepsy, whether the seizure focus can be identified, and other clinical factors. Vagal Nerve Stimulation (VNS) does not require identification of the seizure focus and also carries an FDA indication for depression. While in the United States VNS is only approved for use in partial epilepsy, it is commonly used off-label to treat generalized seizures as well. VNS delivers stimulation on a scheduled basis, in response to patient activation, or in response to heart rate increases serving as a proxy for seizures. Responsive Neurostimulation (RNS) requires the identification of up to two seizure foci and delivers stimulation only in response to the detection of epileptiform activity. While it requires intracranial placement of electrodes, it allows for long-term monitoring of electrographic seizures and may be effective where VNS has not produced an optimal response. Deep brain stimulation of the anterior nucleus of the thalamus is not FDA approved at this time but is available in Europe and many other parts of the world. While it also carries an indication only for partial epilepsy, it does not require identification of the seizure focus and may be particularly helpful for temporal lobe epilepsy. It also appears effective in cases where VNS has not been sufficiently helpful. The Trigeminal Nerve Stimulation (TNS) system is another treatment modality which is not yet FDA approved but is available in Europe and other countries. Its mechanism of action is similar to the VNS system and it also appears to have anti-depression effects in addition to anti-epileptic benefits. However, the most compelling feature of TNS is that it is not implanted but rather applied to the skin with transdermal electrodes, typically at night.
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Affiliation(s)
- George Nune
- Department of Neurology, University of Southern California, 1520 San Pablo St. Suite 3000, Los Angeles, CA, 90033, USA,
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373
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Alhourani A, McDowell MM, Randazzo MJ, Wozny TA, Kondylis ED, Lipski WJ, Beck S, Karp JF, Ghuman AS, Richardson RM. Network effects of deep brain stimulation. J Neurophysiol 2015; 114:2105-17. [PMID: 26269552 DOI: 10.1152/jn.00275.2015] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/10/2015] [Indexed: 11/22/2022] Open
Abstract
The ability to differentially alter specific brain functions via deep brain stimulation (DBS) represents a monumental advance in clinical neuroscience, as well as within medicine as a whole. Despite the efficacy of DBS in the treatment of movement disorders, for which it is often the gold-standard therapy when medical management becomes inadequate, the mechanisms through which DBS in various brain targets produces therapeutic effects is still not well understood. This limited knowledge is a barrier to improving efficacy and reducing side effects in clinical brain stimulation. A field of study related to assessing the network effects of DBS is gradually emerging that promises to reveal aspects of the underlying pathophysiology of various brain disorders and their response to DBS that will be critical to advancing the field. This review summarizes the nascent literature related to network effects of DBS measured by cerebral blood flow and metabolic imaging, functional imaging, and electrophysiology (scalp and intracranial electroencephalography and magnetoencephalography) in order to establish a framework for future studies.
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Affiliation(s)
- Ahmad Alhourani
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael M McDowell
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael J Randazzo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas A Wozny
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Witold J Lipski
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Beck
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Avniel S Ghuman
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania
| | - R Mark Richardson
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for the Neural Basis of Cognition, Pittsburgh, Pennsylvania
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374
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Valentin A, Ughratdar I, Cheserem B, Morris R, Selway R, Alarcon G. Epilepsia partialis continua responsive to neocortical electrical stimulation. Epilepsia 2015; 56:e104-9. [PMID: 26174165 DOI: 10.1111/epi.13067] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 11/26/2022]
Abstract
Epilepsia partialis continua (EPC), defined as a syndrome of continuous focal jerking, is a rare form of focal status epilepticus that usually affects a distal limb, and when prolonged, can produce long-lasting deficits in limb function. Substantial electrophysiologic evidence links the origin of EPC to the motor cortex; thus surgical resection carries the risk of significant handicap. We present two patients with focal, drug-resistant EPC, who were admitted for intracranial video-electroencephalography monitoring to elucidate the location of the epileptogenic focus and identification of eloquent motor cortex with functional mapping. In both cases, the focus resided at or near eloquent motor cortex and therefore precluded resective surgery. Chronic cortical stimulation delivered through subdural strips at the seizure focus (continuous stimulation at 60-130 Hz, 2-3 mA) resulted in >90% reduction in seizures and abolition of the EPC after a follow-up of 22 months in both patients. Following permanent implantation of cortical stimulators, no adverse effects were noted. EPC restarted when intensity was reduced or batteries depleted. Battery replacement restored previous improvement. This two-case report opens up avenues for the treatment of this debilitating condition.
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Affiliation(s)
- Antonio Valentin
- Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom.,Department of Human Physiology, Faculty of Medicine, University Complutense, Madrid, Spain.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ismail Ughratdar
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Beverly Cheserem
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Robert Morris
- Department of Neurosurgery, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Richard Selway
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Gonzalo Alarcon
- Department of Clinical Neurophysiology, King's College Hospital, London, United Kingdom.,Department of Human Physiology, Faculty of Medicine, University Complutense, Madrid, Spain.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
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375
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Abstract
Single neuron actions and interactions are the sine qua non of brain function, and nearly all diseases and injuries of the CNS trace their clinical sequelae to neuronal dysfunction or failure. Remarkably, discussion of neuronal activity is largely absent in clinical neuroscience. Advances in neurotechnology and computational capabilities, accompanied by shifts in theoretical frameworks, have led to renewed interest in the information represented by single neurons. Using direct interfaces with the nervous system, millisecond-scale information will soon be extracted from single neurons in clinical environments, supporting personalized treatment of neurologic and psychiatric disease. In this Perspective, we focus on single-neuronal activity in restoring communication and motor control in patients suffering from devastating neurological injuries. We also explore the single neuron's role in epilepsy and movement disorders, surgical anesthesia, and in cognitive processes disrupted in neurodegenerative and neuropsychiatric disease. Finally, we speculate on how technological advances will revolutionize neurotherapeutics.
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Affiliation(s)
- Sydney S Cash
- Neurotechnology Trials Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| | - Leigh R Hochberg
- Neurotechnology Trials Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; School of Engineering and Institute for Brain Science, Brown University, Providence, RI 02912, USA; Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI 02908, USA.
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376
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King-Stephens D, Mirro E, Weber PB, Laxer KD, Van Ness PC, Salanova V, Spencer DC, Heck CN, Goldman A, Jobst B, Shields DC, Bergey GK, Eisenschenk S, Worrell GA, Rossi MA, Gross RE, Cole AJ, Sperling MR, Nair DR, Gwinn RP, Park YD, Rutecki PA, Fountain NB, Wharen RE, Hirsch LJ, Miller IO, Barkley GL, Edwards JC, Geller EB, Berg MJ, Sadler TL, Sun FT, Morrell MJ. Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography. Epilepsia 2015; 56:959-67. [PMID: 25988840 PMCID: PMC4676303 DOI: 10.1111/epi.13010] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with suspected mesial temporal lobe (MTL) epilepsy typically undergo inpatient video-electroencephalography (EEG) monitoring with scalp and/or intracranial electrodes for 1 to 2 weeks to localize and lateralize the seizure focus or foci. Chronic ambulatory electrocorticography (ECoG) in patients with MTL epilepsy may provide additional information about seizure lateralization. This analysis describes data obtained from chronic ambulatory ECoG in patients with suspected bilateral MTL epilepsy in order to assess the time required to determine the seizure lateralization and whether this information could influence treatment decisions. METHODS Ambulatory ECoG was reviewed in patients with suspected bilateral MTL epilepsy who were among a larger cohort with intractable epilepsy participating in a randomized controlled trial of responsive neurostimulation. Subjects were implanted with bilateral MTL leads and a cranially implanted neurostimulator programmed to detect abnormal interictal and ictal ECoG activity. ECoG data stored by the neurostimulator were reviewed to determine the lateralization of electrographic seizures and the interval of time until independent bilateral MTL electrographic seizures were recorded. RESULTS Eighty-two subjects were implanted with bilateral MTL leads and followed for 4.7 years on average (median 4.9 years). Independent bilateral MTL electrographic seizures were recorded in 84%. The average time to record bilateral electrographic seizures in the ambulatory setting was 41.6 days (median 13 days, range 0-376 days). Sixteen percent had only unilateral electrographic seizures after an average of 4.6 years of recording. SIGNIFICANCE About one third of the subjects implanted with bilateral MTL electrodes required >1 month of chronic ambulatory ECoG before the first contralateral MTL electrographic seizure was recorded. Some patients with suspected bilateral MTL seizures had only unilateral electrographic seizures. Chronic ambulatory ECoG in patients with suspected bilateral MTL seizures provides data in a naturalistic setting, may complement data from inpatient video-EEG monitoring, and can contribute to treatment decisions.
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Affiliation(s)
- David King-Stephens
- Pacific Epilepsy Program, Pacific Medical Center, San Francisco, California, 94115, U.S.A
| | - Emily Mirro
- NeuroPace, Inc., Mountain View, California, 94043, U.S.A
| | - Peter B Weber
- Pacific Epilepsy Program, Pacific Medical Center, San Francisco, California, 94115, U.S.A
| | - Kenneth D Laxer
- Pacific Epilepsy Program, Pacific Medical Center, San Francisco, California, 94115, U.S.A
| | - Paul C Van Ness
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, 75390, U.S.A
| | - Vicenta Salanova
- Department of Neurology, Indiana University, Indianapolis, Indiana, 46202, U.S.A
| | - David C Spencer
- Oregon Health and Science University, Portland, Oregon, 97239, U.S.A
| | - Christianne N Heck
- USC Comprehensive Epilepsy Program, Los Angeles, California, 90089, U.S.A
| | - Alica Goldman
- Baylor College of Medicine, Houston, Texas, 77030, U.S.A
| | - Barbara Jobst
- Dartmouth-Hitchcock Epilepsy Center, Lebanon, New Hampshire, 03756, U.S.A
| | - Donald C Shields
- George Washington University, Washington, District of Columbia, 20052, U.S.A
| | - Gregory K Bergey
- Johns Hopkins Epilepsy Center, Baltimore, Maryland, 21287, U.S.A
| | - Stephan Eisenschenk
- Department of Neurology, University of Florida, Gainesville, Florida, 32611, U.S.A
| | - Gregory A Worrell
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, 55905, U.S.A
| | | | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Andrew J Cole
- MGH Epilepsy Service, Massachusetts General Hospital, Boston, Massachusetts, 02114, U.S.A
| | - Michael R Sperling
- Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, 19107, U.S.A
| | - Dileep R Nair
- Cleveland Clinic Neurological Institute, Cleveland, Ohio, 44195, U.S.A
| | - Ryder P Gwinn
- Swedish Neuroscience Institute, Seattle, Washington, 98052, U.S.A
| | - Yong D Park
- Georgia Regents University, Augusta, Georgia, 30912, U.S.A
| | - Paul A Rutecki
- University of Wisconsin, Madison, Wisconsin, 53792, U.S.A
| | - Nathan B Fountain
- Comprehensive Epilepsy Center, University of Virginia, Charlottesville, Virginia, 22908, U.S.A
| | - Robert E Wharen
- Mayo Clinic Jacksonville, Jacksonville, Florida, 32224, U.S.A
| | - Lawrence J Hirsch
- Yale University School of Medicine, New Haven, Connecticut, 06510, U.S.A
| | - Ian O Miller
- Comprehensive Epilepsy Center, Miami Children's Hospital, Miami, Florida, 33155, U.S.A
| | | | - Jonathan C Edwards
- The Medical University of South Carolina, Charleston, South Carolina, 29425, U.S.A
| | - Eric B Geller
- Institute of Neurology and Neurosurgery at Saint Barnabas, Livingston, New Jersey, 07039, U.S.A
| | - Michel J Berg
- University of Rochester Medical Center, Rochester, New York, 14642, U.S.A
| | - Toni L Sadler
- Via Christi Comprehensive Epilepsy Center, Wichita, Kansas, 67214, U.S.A
| | - Felice T Sun
- NeuroPace, Inc., Mountain View, California, 94043, U.S.A
| | - Martha J Morrell
- NeuroPace, Inc., Mountain View, California, 94043, U.S.A.,Stanford Comprehensive Epilepsy Center, Stanford, California, 94305, U.S.A
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377
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Abstract
In a long-term clinical trial, a responsive neurostimulation system was shown to reduce seizures and improve quality of life in patients with drug-resistant epilepsy. Furthermore, these effects persisted over an extended time period. Will neurostimulation close the treatment gap for patients with refractory epilepsy?
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Affiliation(s)
- Kristl Vonck
- Department of Neurology, Reference Centre for Refractory Epilepsy, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Paul Boon
- Department of Neurology, Reference Centre for Refractory Epilepsy, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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378
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