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Responsive Neurostimulation for Seizure Control: Current Status and Future Directions

BIOMEDICINES (2022)

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Article Clinical Neurology

Machine Learning to Classify Relative Seizure Frequency From Chronic Electrocorticography

Yueqiu Sun et al.

Summary: This study aimed to explore the application of machine learning algorithms in responsive neurostimulation therapy to assess the clinical response to changes in neurostimulation parameters. By analyzing the data and training models, it was found that high gamma power was one of the most informative features, and individual circadian patterns of seizure activity could guide model building.

JOURNAL OF CLINICAL NEUROPHYSIOLOGY (2023)

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Article Clinical Neurology

Bilateral temporal lobe epilepsy: How many seizures are required in chronic ambulatory electrocorticography to estimate the laterality ratio?

Sharon Chiang et al.

Summary: Approximately 8 months of chronic RNS ECoG are needed to precisely estimate the seizure laterality ratio in patients with drug-resistant BTLE, with 75% of patients achieving convergence after 1 year of recording. Optimized recording duration may help avoid morbidity associated with delay to definitive treatment for individuals who are candidates for unilateral resection based on seizure laterality.

EPILEPSIA (2022)

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Article Clinical Neurology

United States Epilepsy Center Characteristics A Data Analysis From the National Association of Epilepsy Centers

Adam P. Ostendorf et al.

Summary: The number of NAEC accredited epilepsy centers in the United States has increased, with growth seen in EMU admissions, EMU beds, and epileptologists per population from 2012 to 2019. Access to specialized testing and services has expanded, but aggregate surgical volume has remained stable or declined for most procedure types.

NEUROLOGY (2022)

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Article Clinical Neurology

Patient-specific structural connectivity informs outcomes of responsive neurostimulation for temporal lobe epilepsy

Chantel M. Charlebois et al.

Summary: This study aimed to investigate the effectiveness of responsive neurostimulation in the mesial temporal lobe and identify stimulation-dependent networks associated with seizure reduction. The results showed that patient-specific stimulation-dependent connectivity was correlated with treatment effectiveness, while normative connectivity was not. Increased connectivity to the medial prefrontal cortex, cingulate cortex, and precuneus was associated with greater seizure reduction.

EPILEPSIA (2022)

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Article Clinical Neurology

Responsive neurostimulation of the thalamus improves seizure control in idiopathic generalised epilepsy: initial case series

Nathaniel D. Sisterson et al.

Summary: This study reported outcomes of four patients with pharmacoresistant epilepsy undergoing thalamic-responsive neurostimulation treatment, showing a significant reduction in seizure frequency, duration and severity, as well as improvements in quality of life. The results remained durable through at least 2 years of therapy.

JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY (2022)

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Article Clinical Neurology

Network connectivity predicts effectiveness of responsive neurostimulation in focal epilepsy

Joline M. Fan et al.

Summary: This study aimed to investigate whether non-invasively measured functional brain connectivity can predict clinical response to responsive neurostimulation therapy. The findings suggest that patients with lower global functional connectivity in the alpha and beta frequency bands are less likely to respond to neurostimulation therapy. Functional connectivity predicted responder status more strongly than hemispheric predictors, and lobar functional connectivity was not a predictor.

BRAIN COMMUNICATIONS (2022)

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Article Clinical Neurology

Identifying the neural network for neuromodulation in epilepsy through connectomics and graphs

Artur Vetkas et al.

Summary: The researchers identified a brain network associated with neuromodulation targets for epilepsy using functional connectivity maps. This network could potentially serve as a biomarker for patient selection, treatment parameters, and neuromodulation targets. The study provides important insights into the mechanism of neuromodulation in epilepsy and the potential use of biomarkers for optimizing treatment.

BRAIN COMMUNICATIONS (2022)

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Article Engineering, Biomedical

The RNS System: brain-responsive neurostimulation for the treatment of epilepsy

Beata Jarosiewicz et al.

Summary: This review discusses the NeuroPace RNS System, the only brain-responsive neurostimulation device, and the results of multi-year clinical trials. Brain-responsive neurostimulation has the potential to be used for treating episodic neurological disorders with a neurophysiological biomarker of severity, and combining advanced machine learning with chronic ambulatory brain data collected by the RNS System could lead to personalized treatment for each patient.

EXPERT REVIEW OF MEDICAL DEVICES (2021)

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Article Clinical Neurology

Selection of deep brain stimulation contacts using volume of tissue activated software following subthalamic nucleus stimulation

Mathilde Devaluez et al.

Summary: High-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in treating motor symptoms of Parkinson's disease. Using patient-specific lead and volume of tissue activated (VTA) software, researchers found that VTA software had significant concordance with clinical data in selecting contacts and stimulation parameters for postoperative follow-up and programming. The study showed that VTA software can assist in determining the clinical effectiveness of stimulation in Parkinson's disease patients undergoing DBS of the STN.

JOURNAL OF NEUROSURGERY (2021)

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Review Engineering, Biomedical

Chronic electroencephalography in epilepsy with a responsive neurostimulation device: current status and future prospects

Vikram R. Rao

Summary: This review focuses on clinical insights and basic neuroscience discoveries enabled by analyses of cEEG from the NeuroPace RNS System, highlighting the importance of the wide temporal lens of cEEG in capturing the dynamism of epilepsy. While the RNS System is considered a vanguard device with diagnostic utility rivaling its therapeutic benefits, emerging minimally invasive devices promise to be more applicable within a broad population of people with epilepsy.

EXPERT REVIEW OF MEDICAL DEVICES (2021)

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Article Clinical Neurology

Expert-Level Intracranial Electroencephalogram Ictal Pattern Detection by a Deep Learning Neural Network

Alexander C. Constantino et al.

Summary: This study evaluates the efficiency of deep learning methodology in detecting iEEG seizures using a large dataset of ictal patterns collected from epilepsy patients implanted with a responsive neurostimulation system (RNS). Convolutional neural network (CNN) achieved high accuracy in personalized seizure annotations for each patient in different scenarios. The results suggest potential for automated techniques to significantly improve the management of closed-loop brain stimulation.

FRONTIERS IN NEUROLOGY (2021)

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Review Neurosciences

Under-sampling in epilepsy: Limitations of conventional EEG

Maxime O. Baud et al.

Summary: The cyclical structure of epilepsy has been recently rediscovered through long-term intracranial electroencephalography obtained with implanted devices, providing new insights into the practice and interpretation of conventional EEG. There are caveats to counting epileptiform discharges in short-duration EEG recordings and the limitations of conventional EEG have practical implications for titrating anti-seizure medications and allowing patients to drive. Chronic monitoring of brain activity could greatly improve epilepsy care, and utilizing next-generation devices for chronic EEG could leverage known biomarkers of disease state in an impending paradigm shift in epilepsy care.

CLINICAL NEUROPHYSIOLOGY PRACTICE (2021)

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Review Computer Science, Information Systems

Impact of EEG Parameters Detecting Dementia Diseases: A Systematic Review

Luz-Maria Sanchez-Reyes et al.

Summary: The study thoroughly reviewed the results of using EEG systems for the detection of dementia diseases, finding common combinations with reliability levels exceeding 90% and detailing considerations at each stage, as well as describing the most commonly used classification tools and processing techniques.

IEEE ACCESS (2021)

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Review Geriatrics & Gerontology

Neuromodulation in Drug Resistant Epilepsy

Natalia Rincon et al.

Summary: Epilepsy affects millions worldwide, with drug-resistant cases posing a challenge for surgical intervention. Neuromodulation therapies like VNS, RNS, and DBS may offer alternative treatment options for these patients.

AGING AND DISEASE (2021)

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Article Computer Science, Information Systems

Cortical Activity at Baseline and During Light Stimulation in Patients With Strabismus and Amblyopia

Danjela Ibrahimi et al.

Summary: This research compares cortical activity in patients with strabismus and amblyopia with healthy controls, finding distinct differences at baseline and during light stimulation. Light stimulation modulates brain activity in SA patients, increasing connectivity and enhancing neural activation, indicating its potential as a brain stimulator for these conditions.

IEEE ACCESS (2021)

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Article Clinical Neurology

Responsive Neurostimulation as a Novel Palliative Option in Epilepsy Surgery

Motoki Inaji et al.

Summary: The RNS System, a novel palliative option for drug-resistant epilepsy, continuously monitors and responds with electrical stimulation to reduce seizures, showing promising efficacy especially in mesial temporal lobe epilepsy and neocortical epilepsy.

NEUROLOGIA MEDICO-CHIRURGICA (2021)

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Review Clinical Neurology

Controversies on the network theory of epilepsy: Debates held during the ICTALS 2019 conference

Hitten P. Zaveri et al.

SEIZURE-EUROPEAN JOURNAL OF EPILEPSY (2020)

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Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy

Dileep R. Nair et al.

NEUROLOGY (2020)

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Neuromodulation of Epilepsy Networks

Nathaniel D. Sisterson et al.

NEUROSURGERY CLINICS OF NORTH AMERICA (2020)

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Cortex leads the thalamic centromedian nucleus in generalized epileptic discharges in Lennox-Gastaut syndrome

Linda J. Dalic et al.

EPILEPSIA (2020)

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Removal of Interictal MEG-Derived Network Hubs Is Associated With Postoperative Seizure Freedom

Sriharsha Ramaraju et al.

FRONTIERS IN NEUROLOGY (2020)

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Review Clinical Neurology

Learnings from 30 years of reported efficacy and safety of vagus nerve stimulation (VNS) for epilepsy treatment: A critical review

Denahin Hinnoutondji Toffa et al.

SEIZURE-EUROPEAN JOURNAL OF EPILEPSY (2020)

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Article Clinical Neurology

Treatment of Multi-Focal Epilepsy With Resective Surgery Plus Responsive Neurostimulation (RNS): One Institution's Experience

Diem Kieu Tran et al.

FRONTIERS IN NEUROLOGY (2020)

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Review Medicine, General & Internal

Epilepsy in adults

Roland D. Thijs et al.

LANCET (2019)

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Deep brain stimulation: current challenges and future directions

Andres M. Lozano et al.

NATURE REVIEWS NEUROLOGY (2019)

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Association of Closed-Loop Brain Stimulation Neurophysiological Features With Seizure Control Among Patients With Focal Epilepsy

Vasileios Kokkinos et al.

JAMA NEUROLOGY (2019)

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Comparison and Selection of Current Implantable Anti-Epileptic Devices

Stephen Wong et al.

NEUROTHERAPEUTICS (2019)

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A New Approach for Motor Imagery Classification Based on Sorted Blind Source Separation, Continuous Wavelet Transform, and Convolutional Neural Network

Cesar J. Ortiz-Echeverri et al.

SENSORS (2019)

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Association of Seizure Spread With Surgical Failure in Epilepsy

John P. Andrews et al.

JAMA NEUROLOGY (2019)

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The Present and Future of Vagus Nerve Stimulation

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JOURNAL OF KOREAN NEUROSURGICAL SOCIETY (2019)

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Getting the best outcomes from epilepsy surgery

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ANNALS OF NEUROLOGY (2018)

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Neurostimulation for the treatment of epilepsy

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Responsive neurostimulation: Review of clinical trials and insights into focal epilepsy

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Differences in functional connectivity profiles as a predictor of response to anterior thalamic nucleus deep brain stimulation for epilepsy: a hypothesis for the mechanism of action and a potential biomarker for outcomes

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NEUROSURGICAL FOCUS (2018)

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A Comparison of Vagal Nerve Stimulation and Responsive Neurostimulation for the Treatment of Medically Refractory Complex Partial Epilepsy

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STEREOTACTIC AND FUNCTIONAL NEUROSURGERY (2018)

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Responsive neurostimulation: Candidates and considerations

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Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy

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Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas

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ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology

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MRI-Guided Laser Interstitial Thermal Therapy for Epilepsy

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NEUROSURGERY CLINICS OF NORTH AMERICA (2017)

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FRONTIERS IN NEUROINFORMATICS (2017)

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Review Clinical Neurology

The history of invasive EEG evaluation in epilepsy patients

Philipp S. Reiff et al.

SEIZURE-EUROPEAN JOURNAL OF EPILEPSY (2016)

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Long-term treatment with responsive brain stimulation in adults with refractory partial seizures

Gregory K. Bergey et al.

NEUROLOGY (2015)

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Article Engineering, Biomedical

The RNS System: responsive cortical stimulation for the treatment of refractory partial epilepsy

Felice T. Sun et al.

EXPERT REVIEW OF MEDICAL DEVICES (2014)

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Article Clinical Neurology

Deep brain stimulation of the centromedian thalamic nucleus for the treatment of generalized and frontal epilepsies

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Early Surgical Therapy for Drug-Resistant Temporal Lobe Epilepsy A Randomized Trial

Jerome Engel et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2012)

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Background intracranial EEG spectral changes with anti-epileptic drug taper

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Overview of the Clinical Applications of Vagus Nerve Stimulation

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JOURNAL OF CLINICAL NEUROPHYSIOLOGY (2010)

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Neuropathology of focal epilepsies: A critical review

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A decrease in EEG energy accompanies anti-epileptic drug taper during intracranial monitoring

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The first case of invasive EEG monitoring for the surgical treatment of epilepsy: Historical significance and context

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EPILEPSIA (2005)

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NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS (2005)

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Practice parameter: Temporal lobe and localized neocortical resections for epilepsy - Report of the quality standards subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons

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