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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 offers 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...
February 6, 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
Karl A Sillay, Paul Rutecki, Kathy Cicora, Greg Worrell, Joseph Drazkowski, Jerry J Shih, Ashwini D Sharan, Martha J Morrell, Justin Williams, Brett Wingeier
Long-term stability of the electrode-tissue interface may be required to maintain optimal neural recording with subdural and deep brain implants and to permit appropriate delivery of neuromodulation therapy. Although short-term changes in impedance at the electrode-tissue interface are known to occur, long-term changes in impedance have not previously been examined in detail in humans. To provide further information about short- and long-term impedance changes in chronically implanted electrodes, a dataset from 191 persons with medically intractable epilepsy participating in a trial of an investigational responsive neurostimulation device (the RNS(®) System, NeuroPace, Inc...
September 2013: Brain Stimulation
Jared Fridley, Jonathan G Thomas, Jovany Cruz Navarro, Daniel Yoshor
The treatment of patients with refractory epilepsy has always been challenging. Despite the availability of multiple antiepileptic medications and surgical procedures with which to resect seizure foci, there is a subset of epilepsy patients for whom little can be done. Currently available treatment options for these unfortunate patients include vagus nerve stimulation, the ketogenic diet, and electric stimulation, both direct and indirect, of brain nuclei thought to be involved in epileptogenesis. Studies of electrical stimulation of the brain in epilepsy treatment date back to the early 20th century, beginning with research on cerebellar stimulation...
March 2012: Neurosurgical Focus
Vikaas S Sohal, Felice T Sun
Deep brain stimulation (DBS) is an established treatment for Parkinson's disease, and is increasingly used for other neuropsychiatric conditions including epilepsy. Nevertheless, neural mechanisms for DBS and other forms of neurostimulation remain elusive. The authors measured effects of responsive neurostimulation on intracranially recorded activity from participants in a clinical investigation to assess the safety of an implantable responsive neurostimulation system in epilepsy (RNS™ System, NeuroPace, Inc...
October 2011: Neurosurgery Clinics of North America
Paul R Gigante, Robert R Goodman
The mainstay of epilepsy surgery is the resection of a presumed seizure focus or disruption of seizure propagation pathways. These approaches cannot be applied to all patients with medically refractory epilepsy (MRE). Since 1997, vagus nerve stimulation has been a palliative adjunct to the care of MRE patients. Deep brain stimulation (DBS) in select locations has been reported to reduce seizure frequency in small studies over the past three decades. Recently published results from the SANTE (Stimulation of the Anterior Nuclei of Thalamus for Epilepsy) trial-the first large-scale, randomized, double-blind trial of bilateral anterior thalamus DBS for MRE-demonstrate a significant reduction in seizure frequency with programmed stimulation...
August 2011: Current Neurology and Neuroscience Reports
Valeriya S Poukas, John R Pollard, Christopher Todd Anderson
Most medical therapies for epilepsy consist of daily (or multiple-daily) dose, fixed-schedule, pharmacologic oral agents. Despite adherence, many patients continue to experience seizures. Various products have been discovered, designed, and marketed to serve as seizure-abortant therapies. These agents can be administered rapidly, as a "rescue" therapy, once a clinical seizure or cluster of seizures starts. Rescue medications are given as needed in an attempt to disrupt progression of a given seizure, and forestall what would otherwise be a more prolonged or more severe clinical event...
August 2011: Current Neurology and Neuroscience Reports
Naoki Akamatsu, Sadatoshi Tsuji
Despite the advances in pharmacologic treatments for epilepsy, approximately one-third of patients with epilepsy continue to have seizures, and alternative treatment approaches are necessary in such cases. For many patients, resective surgery can be an alternative for achieving seizure freedom; however, its success depend on identifying seizure foci before surgery. Many patients with medically intractable epilepsy are not suitable candidates for surgery. The therapeutic effect of electrical stimulation on the brain has been studied for decades...
April 2011: Brain and Nerve, Shinkei Kenkyū No Shinpo
David Spencer, Ryder Gwinn, Martin Salinsky, Jean P O'Malley
We describe seizure laterality and temporal seizure patterns in six subjects with bilateral temporal lobe epilepsy (bTLE) implanted with bilateral hippocampal depth electrodes and the NeuroPace RNS™ system over 84 consecutive days. Seizures were disproportionate in laterality in three subjects and disproportionate in time for two subjects. Clustering of seizures did not clearly affect laterality. Some but not all subjects with bTLE displayed nonrandom temporal or lateral clustering of seizures.
February 2011: Epilepsy Research
Felice T Sun, Martha J Morrell, Robert E Wharen
Epilepsy is a common chronic neurological disorder affecting approximately 1-2% of the population. Despite the available treatment options (pharmacotherapy, surgery, and vagus nerve stimulation), a large percentage of patients continue to have seizures. With the success of deep brain stimulation for treatment of movement disorders, brain stimulation has received renewed attention as a potential treatment option for epilepsy. Responsive stimulation aims to suppress epileptiform activity by delivering stimulation directly in response to electrographic activity...
January 2008: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
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