Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings

George Nune, Sharanya Arcot Desai, Babak Razavi, Mark A. Agostini, Gregory K Bergey, Aamr A. Herekar, Lawrence J. Hirsch, Ricky W. Lee, Paul A. Rutecki, Shraddha Srinivasan, Paul C. Van Ness, Thomas K. Tcheng, Martha J. Morrell

Research output: Contribution to journalArticle

Abstract

Objectives: Describe changes in clinical seizure frequency and electrophysiological data recorded in patients with medically-intractable seizures and periventricular nodular heterotopias (PVNH) treated with the RNS® System (NeuroPace, Inc., Mountain View, CA). Methods: Clinical seizures from eight patients (mean follow-up of 10.1 years) were analyzed pre- and post-treatment. Chronic ambulatory electrocorticograms (ECoGs) recorded from PVNHs, hippocampus and neocortex were evaluated to identify the earliest electrographic seizure onset type, pattern of spread, and interictal characteristics. Results: Mean reduction in disabling seizures was 85.7 % (n = 8); seven patients had >50% seizure reduction and two were seizure-free in the final year of analysis. Seizure rate showed a progressive reduction over the course of the study with the highest rate of improvement in the first two to three years after implantation. Four of seven patients with one PVNH lead and a second lead in the hippocampus or neocortex had some electrographic seizures first recorded at either lead location, suggesting two foci or seizure propagation patterns. Low voltage fast type activity was the prominent seizure onset pattern. Interictal ECoG power was lower in PVNH than hippocampus. Conclusions: RNS® System treatment substantially reduced clinical seizure frequency in patients with PVNH. Analysis of ictal ECoG records suggests PVNH may be involved in seizure generation. Significance: Chronic ECoG recordings suggest PVNH tissue can actively participate in epileptogenic networks. Direct brain-responsive neurostimulation is a safe and effective treatment option in such patients, progressively reducing seizure rate over a period of years.

Original languageEnglish (US)
Pages (from-to)1196-1207
Number of pages12
JournalClinical Neurophysiology
Volume130
Issue number8
DOIs
StatePublished - Aug 1 2019

Fingerprint

Periventricular Nodular Heterotopia
Seizures
Therapeutics
Hippocampus
Neocortex
Drug Resistant Epilepsy

Keywords

  • Brain-responsive neurostimulation
  • Focal seizures
  • Medically-intractable epilepsy
  • Periventricular nodular heterotopia (PVNH)
  • RNS® System

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System : Efficacy and description of chronic electrophysiological recordings. / Nune, George; Arcot Desai, Sharanya; Razavi, Babak; Agostini, Mark A.; Bergey, Gregory K; Herekar, Aamr A.; Hirsch, Lawrence J.; Lee, Ricky W.; Rutecki, Paul A.; Srinivasan, Shraddha; Van Ness, Paul C.; Tcheng, Thomas K.; Morrell, Martha J.

In: Clinical Neurophysiology, Vol. 130, No. 8, 01.08.2019, p. 1196-1207.

Research output: Contribution to journalArticle

Nune, G, Arcot Desai, S, Razavi, B, Agostini, MA, Bergey, GK, Herekar, AA, Hirsch, LJ, Lee, RW, Rutecki, PA, Srinivasan, S, Van Ness, PC, Tcheng, TK & Morrell, MJ 2019, 'Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings', Clinical Neurophysiology, vol. 130, no. 8, pp. 1196-1207. https://doi.org/10.1016/j.clinph.2019.04.706
Nune, George ; Arcot Desai, Sharanya ; Razavi, Babak ; Agostini, Mark A. ; Bergey, Gregory K ; Herekar, Aamr A. ; Hirsch, Lawrence J. ; Lee, Ricky W. ; Rutecki, Paul A. ; Srinivasan, Shraddha ; Van Ness, Paul C. ; Tcheng, Thomas K. ; Morrell, Martha J. / Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System : Efficacy and description of chronic electrophysiological recordings. In: Clinical Neurophysiology. 2019 ; Vol. 130, No. 8. pp. 1196-1207.
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abstract = "Objectives: Describe changes in clinical seizure frequency and electrophysiological data recorded in patients with medically-intractable seizures and periventricular nodular heterotopias (PVNH) treated with the RNS{\circledR} System (NeuroPace, Inc., Mountain View, CA). Methods: Clinical seizures from eight patients (mean follow-up of 10.1 years) were analyzed pre- and post-treatment. Chronic ambulatory electrocorticograms (ECoGs) recorded from PVNHs, hippocampus and neocortex were evaluated to identify the earliest electrographic seizure onset type, pattern of spread, and interictal characteristics. Results: Mean reduction in disabling seizures was 85.7 {\%} (n = 8); seven patients had >50{\%} seizure reduction and two were seizure-free in the final year of analysis. Seizure rate showed a progressive reduction over the course of the study with the highest rate of improvement in the first two to three years after implantation. Four of seven patients with one PVNH lead and a second lead in the hippocampus or neocortex had some electrographic seizures first recorded at either lead location, suggesting two foci or seizure propagation patterns. Low voltage fast type activity was the prominent seizure onset pattern. Interictal ECoG power was lower in PVNH than hippocampus. Conclusions: RNS{\circledR} System treatment substantially reduced clinical seizure frequency in patients with PVNH. Analysis of ictal ECoG records suggests PVNH may be involved in seizure generation. Significance: Chronic ECoG recordings suggest PVNH tissue can actively participate in epileptogenic networks. Direct brain-responsive neurostimulation is a safe and effective treatment option in such patients, progressively reducing seizure rate over a period of years.",
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T1 - Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System

T2 - Efficacy and description of chronic electrophysiological recordings

AU - Nune, George

AU - Arcot Desai, Sharanya

AU - Razavi, Babak

AU - Agostini, Mark A.

AU - Bergey, Gregory K

AU - Herekar, Aamr A.

AU - Hirsch, Lawrence J.

AU - Lee, Ricky W.

AU - Rutecki, Paul A.

AU - Srinivasan, Shraddha

AU - Van Ness, Paul C.

AU - Tcheng, Thomas K.

AU - Morrell, Martha J.

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Y1 - 2019/8/1

N2 - Objectives: Describe changes in clinical seizure frequency and electrophysiological data recorded in patients with medically-intractable seizures and periventricular nodular heterotopias (PVNH) treated with the RNS® System (NeuroPace, Inc., Mountain View, CA). Methods: Clinical seizures from eight patients (mean follow-up of 10.1 years) were analyzed pre- and post-treatment. Chronic ambulatory electrocorticograms (ECoGs) recorded from PVNHs, hippocampus and neocortex were evaluated to identify the earliest electrographic seizure onset type, pattern of spread, and interictal characteristics. Results: Mean reduction in disabling seizures was 85.7 % (n = 8); seven patients had >50% seizure reduction and two were seizure-free in the final year of analysis. Seizure rate showed a progressive reduction over the course of the study with the highest rate of improvement in the first two to three years after implantation. Four of seven patients with one PVNH lead and a second lead in the hippocampus or neocortex had some electrographic seizures first recorded at either lead location, suggesting two foci or seizure propagation patterns. Low voltage fast type activity was the prominent seizure onset pattern. Interictal ECoG power was lower in PVNH than hippocampus. Conclusions: RNS® System treatment substantially reduced clinical seizure frequency in patients with PVNH. Analysis of ictal ECoG records suggests PVNH may be involved in seizure generation. Significance: Chronic ECoG recordings suggest PVNH tissue can actively participate in epileptogenic networks. Direct brain-responsive neurostimulation is a safe and effective treatment option in such patients, progressively reducing seizure rate over a period of years.

AB - Objectives: Describe changes in clinical seizure frequency and electrophysiological data recorded in patients with medically-intractable seizures and periventricular nodular heterotopias (PVNH) treated with the RNS® System (NeuroPace, Inc., Mountain View, CA). Methods: Clinical seizures from eight patients (mean follow-up of 10.1 years) were analyzed pre- and post-treatment. Chronic ambulatory electrocorticograms (ECoGs) recorded from PVNHs, hippocampus and neocortex were evaluated to identify the earliest electrographic seizure onset type, pattern of spread, and interictal characteristics. Results: Mean reduction in disabling seizures was 85.7 % (n = 8); seven patients had >50% seizure reduction and two were seizure-free in the final year of analysis. Seizure rate showed a progressive reduction over the course of the study with the highest rate of improvement in the first two to three years after implantation. Four of seven patients with one PVNH lead and a second lead in the hippocampus or neocortex had some electrographic seizures first recorded at either lead location, suggesting two foci or seizure propagation patterns. Low voltage fast type activity was the prominent seizure onset pattern. Interictal ECoG power was lower in PVNH than hippocampus. Conclusions: RNS® System treatment substantially reduced clinical seizure frequency in patients with PVNH. Analysis of ictal ECoG records suggests PVNH may be involved in seizure generation. Significance: Chronic ECoG recordings suggest PVNH tissue can actively participate in epileptogenic networks. Direct brain-responsive neurostimulation is a safe and effective treatment option in such patients, progressively reducing seizure rate over a period of years.

KW - Brain-responsive neurostimulation

KW - Focal seizures

KW - Medically-intractable epilepsy

KW - Periventricular nodular heterotopia (PVNH)

KW - RNS® System

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