Effect of an external responsive neurostimulator on seizures and electrographic discharges during subdural electrode monitoring.
OBJECTIVE
Approved neural-stimulation therapies for epilepsy use prolonged intermittent stimulation paradigms with no ability to respond automatically to seizures.


METHODS
A responsive neurostimulator that can automatically analyze electrocortical potentials, detect electrographic seizures, and rapidly deliver targeted electrical stimuli to suppress them was evaluated in an open multicenter trial in 50 patients, 40 of whom received responsive cortical stimulation via subdural electrodes implanted for epilepsy surgery evaluations.


RESULTS
Four patients, ages 15 to 28 years, monitored at three institutions, with clinical and electrographic response to neurostimulation, are described. Electrographic seizures were altered and suppressed in these patients during trials of neurostimulation lasting < or =68 h, with no major side effects. In one patient, stimulation appeared also to improve the baseline EEG.


CONCLUSIONS
Responsive cortical neurostimulation may be a safe and effective treatment for partial epilepsy. This information was derived from a small group of patients in an observation study. A double-blind, controlled Food and Drug Administration (FDA)-approved study of a permanently implanted responsive neurostimulation system to treat medically refractory partial seizures is under way.
Kossoff
Eric H
EH
Department of Pediatrics and Neurology, Johns Hopkins Hospital, Baltimore, Maryland 21287-1000, USA. ekossoff@jhmi.edu
Ritzl
Eva K
EK
Politsky
Jeffrey M
JM
Murro
Anthony M
AM
Smith
Joseph R
JR
Duckrow
Robert B
RB
Spencer
Dennis D
DD
Bergey
Gregory K
GK
D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000502:physiology* / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data*; D004828:Epilepsies, Partial / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D012640:Seizures / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D013355:Subdural Space; D013813:Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome