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Lucas R Philipp, Mark R Witcher, Robert E Gross
INTRODUCTION: The Responsive Neurostimulation System (RNS, Neuropace, Mountain View, California) has been proven to be effective at reducing seizures in patients with partial-onset epilepsy. The system incorporates a skull-mounted neurostimulator that requires a cranial incision for replacement. Although integral to the functioning of the system, in some circumstances, such as in the setting of infection, this can be disadvantageous. At present, there are no alternatives to cranial implantation of the RNS System...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
Zahra M Aghajan, Peter Schuette, Tony A Fields, Michelle E Tran, Sameed M Siddiqui, Nicholas R Hasulak, Thomas K Tcheng, Dawn Eliashiv, Emily A Mankin, John Stern, Itzhak Fried, Nanthia Suthana
The theta rhythm-a slow (6-12 Hz) oscillatory component of the local field potential-plays a critical role in spatial navigation and memory by coordinating the activity of neuronal ensembles within the medial temporal lobe (MTL). Although theta has been extensively studied in freely moving rodents, its presence in humans has been elusive and primarily investigated in stationary subjects. Here we used a unique clinical opportunity to examine theta within the human MTL during untethered, real-world ambulatory movement...
December 18, 2017: Current Biology: CB
Pratik Rohatgi, Ryan J Jafrani, Nicholas J Brandmeir, Frank G Gilliam, Tiffany L Fisher, Michael D Sather
BACKGROUND: Patients with bitemporal lobe epilepsy are generally not considered for surgical resection. Fortunately, responsive neurostimulation proves another avenue for the management of this challenging disease process. In conjunction with our epileptologist, we consider responsive neurostimulation for patients who have clinical features of temporal lobe epilepsy without clear localization on imaging and stereo-EEG. METHODS: Here we describe our technique for implanting a responsive neurostimulator (NeuroPace, NeuroPace Inc...
November 14, 2017: World Neurosurgery
Chad R Gordon, Gabriel F Santiago, Judy Huang, Gregory K Bergey, Shuya Liu, Mehran Armand, Henry Brem, William S Anderson
BACKGROUND: Neuromodulation devices have the potential to transform modern day treatments for patients with medicine-resistant neurological disease. For instance, the NeuroPace System (NeuroPace Inc, Mountain View, California) is a Food and Drug Administration (FDA)-approved device developed for closed-loop direct brain neurostimulation in the setting of drug-resistant focal epilepsy. However, current methods require placement either above or below the skull in nonanatomic locations. This type of positioning has several drawbacks including visible deformities and scalp pressure from underneath leading to eventual wound healing difficulties, micromotion of hardware with infection, and extrusion leading to premature explantation...
October 6, 2017: Operative Neurosurgery (Hagerstown, Md.)
Eric B Geller, Tara L Skarpaas, Robert E Gross, Robert R Goodman, Gregory L Barkley, Carl W Bazil, Michael J Berg, Gregory K Bergey, Sydney S Cash, Andrew J Cole, Robert B Duckrow, Jonathan C Edwards, Stephan Eisenschenk, James Fessler, Nathan B Fountain, Alicia M Goldman, Ryder P Gwinn, Christianne Heck, Aamar Herekar, Lawrence J Hirsch, Barbara C Jobst, David King-Stephens, Douglas R Labar, James W Leiphart, W Richard Marsh, Kimford J Meador, Eli M Mizrahi, Anthony M Murro, Dileep R Nair, Katherine H Noe, Yong D Park, Paul A Rutecki, Vicenta Salanova, Raj D Sheth, Donald C Shields, Christopher Skidmore, Michael C Smith, David C Spencer, Shraddha Srinivasan, William Tatum, Paul C Van Ness, David G Vossler, Robert E Wharen, Gregory A Worrell, Daniel Yoshor, Richard S Zimmerman, Kathy Cicora, Felice T Sun, Martha J Morrell
OBJECTIVE: Evaluate the seizure-reduction response and safety of mesial temporal lobe (MTL) brain-responsive stimulation in adults with medically intractable partial-onset seizures of mesial temporal lobe origin. METHODS: Subjects with mesial temporal lobe epilepsy (MTLE) were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline...
June 2017: Epilepsia
Vikram R Rao, Matthew K Leonard, Jonathan K Kleen, Ben A Lucas, Emily A Mirro, Edward F Chang
Direct intracranial recording of human brain activity is an important approach for deciphering neural mechanisms of cognition. Such recordings, usually made in patients with epilepsy undergoing inpatient monitoring for seizure localization, are limited in duration and depend on patients' tolerance for the challenges associated with recovering from brain surgery. Thus, typical intracranial recordings, similar to most non-invasive approaches in humans, provide snapshots of brain activity in acute, highly constrained settings, limiting opportunities to understand long timescale and natural, real-world phenomena...
June 2017: NeuroImage
Mena G Kerolus, Ryan B Kochanski, Marvin Rossi, Michael Stein, Richard W Byrne, Sepehr Sani
INTRODUCTION: Implantation of responsive neurostimulation (RNS) system has been previously discussed in the literature but there is a paucity of data on target accuracy and the use of intraoperative imaging. We describe our experience with 8 patients using intraoperative computed tomography (iCT) during implantation of the NeuroPace RNS system. METHODS: A frame-based system was used. CT images were obtained and merged with preoperative magnetic resonance imaging and metabolic imaging studies to calculate target coordinates...
July 2017: World Neurosurgery
Barbara C Jobst, Ritu Kapur, Gregory L Barkley, Carl W Bazil, Michel J Berg, Gregory K Bergey, Jane G Boggs, Sydney S Cash, Andrew J Cole, Michael S Duchowny, Robert B Duckrow, Jonathan C Edwards, Stephan Eisenschenk, A James Fessler, Nathan B Fountain, Eric B Geller, Alica M Goldman, Robert R Goodman, Robert E Gross, Ryder P Gwinn, Christianne Heck, Aamr A Herekar, Lawrence J Hirsch, David King-Stephens, Douglas R Labar, W R Marsh, Kimford J Meador, Ian Miller, Eli M Mizrahi, Anthony M Murro, Dileep R Nair, Katherine H Noe, Piotr W Olejniczak, Yong D Park, Paul Rutecki, Vicenta Salanova, Raj D Sheth, Christopher Skidmore, Michael C Smith, David C Spencer, Shraddha Srinivasan, William Tatum, Paul Van Ness, David G Vossler, Robert E Wharen, Gregory A Worrell, Daniel Yoshor, Richard S Zimmerman, Tara L Skarpaas, Martha J Morrell
OBJECTIVE: Evaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with medically intractable partial-onset seizures of neocortical origin. METHODS: Patients with partial seizures of neocortical origin were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2-6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline...
June 2017: Epilepsia
Kunal Gupta, Jeffrey S Raskin, Ahmed M Raslan
INTRODUCTION: Surgical resection of a lesion that correlates with seizure onset in patients with epilepsy can dramatically improve seizure burden and quality of life. For bilateral hippocampal lesions, bilateral resection comes with a risk of severe cognitive deficits. Responsive neurostimulation (RNS) devices offer a new modality to treat multifocal lesions in a reversible manner including bilateral hippocampal stimulation. We describe technical aspects of Nexframe-assisted placement of bilateral NeuroPace mesial temporal electrodes and case examples...
May 2017: World Neurosurgery
Hoameng Ung, Kathryn A Davis, Drausin Wulsin, Joost Wagenaar, Emily Fox, John J McDonnell, Ned Patterson, Charles H Vite, Gregory Worrell, Brian Litt
OBJECTIVE: Epilepsy is a chronic disorder, but seizure recordings are usually obtained in the acute setting. The chronic behavior of seizures and the interictal bursts that sometimes initiate them is unknown. We investigate the variability of these electrographic patterns over an extended period of time using chronic intracranial recordings in canine epilepsy. METHODS: Continuous, yearlong intracranial electroencephalography (iEEG) recordings from four dogs with naturally occurring epilepsy were analyzed for seizures and interictal bursts...
December 2016: Epilepsia
David C Spencer, Felice T Sun, Sarah N Brown, Barbara C Jobst, Nathan B Fountain, Victoria S S Wong, Emily A Mirro, Mark Quigg
OBJECTIVE: Previous studies reporting circadian patterns of epileptiform activity and seizures are limited by (1) short-term recording in an epilepsy monitoring unit (EMU) with altered antiepileptic drugs (AEDs) and sleep, or (2) subjective seizure diary reports. We studied circadian patterns using long-term ambulatory intracranial recordings captured by the NeuroPace RNS System. METHODS: Retrospective study of RNS System trial participants with stable detection parameters over a continuous 84-day period...
September 2016: Epilepsia
Steven Baldassano, Drausin Wulsin, Hoameng Ung, Tyler Blevins, Mesha-Gay Brown, Emily Fox, Brian Litt
OBJECTIVE: Recently the FDA approved the first responsive, closed-loop intracranial device to treat epilepsy. Because these devices must respond within seconds of seizure onset and not miss events, they are tuned to have high sensitivity, leading to frequent false positive stimulations and decreased battery life. In this work, we propose a more robust seizure detection model. APPROACH: We use a Bayesian nonparametric Markov switching process to parse intracranial EEG (iEEG) data into distinct dynamic event states...
June 2016: Journal of Neural Engineering
Zhikui Wei, Chad R Gordon, Gregory K Bergey, Justin M Sacks, William S Anderson
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...
April 2016: World Neurosurgery
Martha J Morrell, Casey Halpern
Closed-loop, responsive focal brain stimulation provides a new treatment option for patients with refractory partial onset seizures who are not good candidates for potentially curative epilepsy surgery. The first responsive brain neurostimulator (RNS® System, NeuroPace), provides stimulation directly to the seizure focus when abnormal electrocorticographic is detected. Seizure reductions of 44% at one year increase to 60 to 66% at years 3 to 6 of treatment. There is no negative impact on cognition and mood...
January 2016: Neurosurgery Clinics of North America
George P Thomas, Barbara C Jobst
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...
2015: Medical Devices: Evidence and Research
Brian Lee, Muhammad N Zubair, Yvette D Marquez, David M Lee, Laura A Kalayjian, Christianne N Heck, Charles Y Liu
INTRODUCTION: The clinical results for the RNS System (NeuroPace, Mountain View, California, USA) closed-loop responsive neurostimulator for the treatment of medically intractable partial-onset seizures have been encouraging. The University of Southern California (USC) Neurorestoration Center and the Keck Hospital of USC have become the world's first institutions to implant an RNS System post U.S. Food and Drug Administration (FDA) approval. As one of the study centers, we review our experience with our group of patients who have been implanted with the RNS System...
September 2015: World Neurosurgery
Otis Smart, John D Rolston, Charles M Epstein, Robert E Gross
This study describes seizure laterality and localization changes over 500 consecutive days in a patient with bilateral temporal lobe epilepsy (BTLE) and implanted NeuroPace RNS™ System. During a continuous two-year time period, the RNS™ device stored 54 hippocampal electrocorticography (ECoG) seizures, which we analyzed to determine their distribution and time variance across hippocampi. We report nonrandom long-term seizure laterality and localization variations, especially in the first 200 days postimplant, despite equivalent total seizure counts in both hippocampi...
2013: Epilepsy & Behavior Case Reports
Vibhor Krishna, Andres M Lozano
Despite medications, resective surgery, and vagal nerve stimulation, some patients with epilepsy continue to have seizures. In these patients, other approaches are urgently needed. The biological basis of stimulation of anterior thalamic nucleus and epileptogenic focus is presented. Results from two large randomized controlled trials Stimulation of Anterior Nucleus of Thalamus for Epilepsy (SANTE) and Neuropace pivotal trial are discussed. Neuromodulation provides effective treatment for a select group of refractory epilepsy patients...
March 2014: Annals of Indian Academy of Neurology
Daniel J DiLorenzo, Erwin Z Mangubat, Marvin A Rossi, Richard W Byrne
OBJECT: Epilepsy surgery is at the cusp of a transformation due to the convergence of advancements in multiple technologies. Emerging neuromodulatory therapies offer the promise of functionally correcting neural instability and obviating the need for resective or ablative surgery in select cases. Chronic implanted neurological monitoring technology, delivered as part of a neuromodulatory therapeutic device or as a stand-alone monitoring system, offers the potential to monitor patients chronically in their normal ambulatory setting with outpatient medication regimens...
June 2014: Journal of Neurosurgery
Eric H Kossoff
There are many children with intractable epilepsy who do not respond to anticonvulsant medications yet are not candidates for resective epilepsy surgery. For these children and more, nonpharmacologic therapies can be very helpful. The primary therapies include diet and neurostimulation. Dietary therapies available currently include the ketogenic diet, modified Atkins diet, medium chain triglyceride diet, and low glycemic index treatment. Neurostimulation, using electricity to abort seizures, includes vagus nerve stimulation only at this time...
2013: Handbook of Clinical Neurology
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