Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings
•Periventricular nodular heterotopia (PVNH) can actively participate in epileptogenic networks.•Low voltage fast activity was the prominent seizure onset pattern in PVNH patients.•RNS® System therapy reduced clinical seizures by 86% in medically-intractable epilepsy with PVNH. Describe changes in cl...
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| Veröffentlicht in: | Clinical neurophysiology 2019-08, Vol.130 (8), p.1196-1207 |
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| creator | 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. |
| description | •Periventricular nodular heterotopia (PVNH) can actively participate in epileptogenic networks.•Low voltage fast activity was the prominent seizure onset pattern in PVNH patients.•RNS® System therapy reduced clinical seizures by 86% in medically-intractable epilepsy with PVNH.
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).
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.
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.
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.
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. |
| doi_str_mv | 10.1016/j.clinph.2019.04.706 |
| format | Article |
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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).
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.
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.
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.
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.</description><identifier>ISSN: 1388-2457</identifier><identifier>EISSN: 1872-8952</identifier><identifier>DOI: 10.1016/j.clinph.2019.04.706</identifier><identifier>PMID: 31163364</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Aged ; Brain Waves ; Brain-responsive neurostimulation ; Deep Brain Stimulation - adverse effects ; Deep Brain Stimulation - instrumentation ; Deep Brain Stimulation - methods ; Drug Resistant Epilepsy - complications ; Drug Resistant Epilepsy - physiopathology ; Drug Resistant Epilepsy - therapy ; Female ; Focal seizures ; Hippocampus - physiopathology ; Humans ; Male ; Medically-intractable epilepsy ; Middle Aged ; Neocortex - physiopathology ; Periventricular nodular heterotopia (PVNH) ; Periventricular Nodular Heterotopia - complications ; Periventricular Nodular Heterotopia - physiopathology ; RNS® System</subject><ispartof>Clinical neurophysiology, 2019-08, Vol.130 (8), p.1196-1207</ispartof><rights>2019 International Federation of Clinical Neurophysiology</rights><rights>Copyright © 2019 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-b912c15d88ba49e2a9ac9597a965f2f308d960a1be8a78276dc3483a8067db553</citedby><cites>FETCH-LOGICAL-c408t-b912c15d88ba49e2a9ac9597a965f2f308d960a1be8a78276dc3483a8067db553</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1388245719308478$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31163364$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nune, George</creatorcontrib><creatorcontrib>Arcot Desai, Sharanya</creatorcontrib><creatorcontrib>Razavi, Babak</creatorcontrib><creatorcontrib>Agostini, Mark A.</creatorcontrib><creatorcontrib>Bergey, Gregory K.</creatorcontrib><creatorcontrib>Herekar, Aamr A.</creatorcontrib><creatorcontrib>Hirsch, Lawrence J.</creatorcontrib><creatorcontrib>Lee, Ricky W.</creatorcontrib><creatorcontrib>Rutecki, Paul A.</creatorcontrib><creatorcontrib>Srinivasan, Shraddha</creatorcontrib><creatorcontrib>Van Ness, Paul C.</creatorcontrib><creatorcontrib>Tcheng, Thomas K.</creatorcontrib><creatorcontrib>Morrell, Martha J.</creatorcontrib><title>Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings</title><title>Clinical neurophysiology</title><addtitle>Clin Neurophysiol</addtitle><description>•Periventricular nodular heterotopia (PVNH) can actively participate in epileptogenic networks.•Low voltage fast activity was the prominent seizure onset pattern in PVNH patients.•RNS® System therapy reduced clinical seizures by 86% in medically-intractable epilepsy with PVNH.
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).
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.
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.
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.
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Brain Waves</subject><subject>Brain-responsive neurostimulation</subject><subject>Deep Brain Stimulation - adverse effects</subject><subject>Deep Brain Stimulation - instrumentation</subject><subject>Deep Brain Stimulation - methods</subject><subject>Drug Resistant Epilepsy - complications</subject><subject>Drug Resistant Epilepsy - physiopathology</subject><subject>Drug Resistant Epilepsy - therapy</subject><subject>Female</subject><subject>Focal seizures</subject><subject>Hippocampus - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Medically-intractable epilepsy</subject><subject>Middle Aged</subject><subject>Neocortex - physiopathology</subject><subject>Periventricular nodular heterotopia (PVNH)</subject><subject>Periventricular Nodular Heterotopia - complications</subject><subject>Periventricular Nodular Heterotopia - physiopathology</subject><subject>RNS® System</subject><issn>1388-2457</issn><issn>1872-8952</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1TAQhSMEoqXwBgh5ySbBdv5sFkioKj9SBRIta8uxJzdzlRsb2ynKSyHxCjwZvtzCktXMWOfM0fgriueMVoyy7tW-MjMufqo4ZbKiTdXT7kFxzkTPSyFb_jD3tRAlb9r-rHgS455S2tOGPy7Oasa6uu6a8-LnbQCdDrAk4kZiw7orA0SMSecX8DiDjxvBhXidMKsi-Y5pIh4C3uUxoFlnHcji7J86QYLgkvOoyRpx2ZEvn25-_SA3W0xweE2uxhGNNhvRiyUWognoE7rlGG6m4BY0BGYwKTg_bRHd7HbZMJMAxgWbF8anxaNRzxGe3deL4uu7q9vLD-X15_cfL99el6ahIpWDZNyw1gox6EYC11Ib2cpey64d-VhTYWVHNRtA6F7wvrOmbkStBe16O7RtfVG8PO31wX1bISZ1wGhgnvUCbo2K84Yz1rZMZmlzkprgYgwwKh_woMOmGFVHWGqvTrDUEZaijcqwsu3FfcI6HMD-M_2lkwVvTgLId94hBBVNhmDAYv6PpKzD_yf8BubDres</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Nune, George</creator><creator>Arcot Desai, Sharanya</creator><creator>Razavi, Babak</creator><creator>Agostini, Mark A.</creator><creator>Bergey, Gregory K.</creator><creator>Herekar, Aamr A.</creator><creator>Hirsch, Lawrence J.</creator><creator>Lee, Ricky W.</creator><creator>Rutecki, Paul A.</creator><creator>Srinivasan, Shraddha</creator><creator>Van Ness, Paul C.</creator><creator>Tcheng, Thomas K.</creator><creator>Morrell, Martha J.</creator><general>Elsevier B.V</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201908</creationdate><title>Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-b912c15d88ba49e2a9ac9597a965f2f308d960a1be8a78276dc3483a8067db553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Brain Waves</topic><topic>Brain-responsive neurostimulation</topic><topic>Deep Brain Stimulation - adverse effects</topic><topic>Deep Brain Stimulation - instrumentation</topic><topic>Deep Brain Stimulation - methods</topic><topic>Drug Resistant Epilepsy - complications</topic><topic>Drug Resistant Epilepsy - physiopathology</topic><topic>Drug Resistant Epilepsy - therapy</topic><topic>Female</topic><topic>Focal seizures</topic><topic>Hippocampus - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Medically-intractable epilepsy</topic><topic>Middle Aged</topic><topic>Neocortex - physiopathology</topic><topic>Periventricular nodular heterotopia (PVNH)</topic><topic>Periventricular Nodular Heterotopia - complications</topic><topic>Periventricular Nodular Heterotopia - physiopathology</topic><topic>RNS® System</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nune, George</creatorcontrib><creatorcontrib>Arcot Desai, Sharanya</creatorcontrib><creatorcontrib>Razavi, Babak</creatorcontrib><creatorcontrib>Agostini, Mark A.</creatorcontrib><creatorcontrib>Bergey, Gregory K.</creatorcontrib><creatorcontrib>Herekar, Aamr A.</creatorcontrib><creatorcontrib>Hirsch, Lawrence J.</creatorcontrib><creatorcontrib>Lee, Ricky W.</creatorcontrib><creatorcontrib>Rutecki, Paul A.</creatorcontrib><creatorcontrib>Srinivasan, Shraddha</creatorcontrib><creatorcontrib>Van Ness, Paul C.</creatorcontrib><creatorcontrib>Tcheng, Thomas K.</creatorcontrib><creatorcontrib>Morrell, Martha J.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neurophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nune, George</au><au>Arcot Desai, Sharanya</au><au>Razavi, Babak</au><au>Agostini, Mark A.</au><au>Bergey, Gregory K.</au><au>Herekar, Aamr A.</au><au>Hirsch, Lawrence J.</au><au>Lee, Ricky W.</au><au>Rutecki, Paul A.</au><au>Srinivasan, Shraddha</au><au>Van Ness, Paul C.</au><au>Tcheng, Thomas K.</au><au>Morrell, Martha J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings</atitle><jtitle>Clinical neurophysiology</jtitle><addtitle>Clin Neurophysiol</addtitle><date>2019-08</date><risdate>2019</risdate><volume>130</volume><issue>8</issue><spage>1196</spage><epage>1207</epage><pages>1196-1207</pages><issn>1388-2457</issn><eissn>1872-8952</eissn><abstract>•Periventricular nodular heterotopia (PVNH) can actively participate in epileptogenic networks.•Low voltage fast activity was the prominent seizure onset pattern in PVNH patients.•RNS® System therapy reduced clinical seizures by 86% in medically-intractable epilepsy with PVNH.
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).
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.
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.
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.
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.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>31163364</pmid><doi>10.1016/j.clinph.2019.04.706</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical neurophysiology, 2019-08, Vol.130 (8), p.1196-1207 |
| issn | 1388-2457 1872-8952 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Aged Brain Waves Brain-responsive neurostimulation Deep Brain Stimulation - adverse effects Deep Brain Stimulation - instrumentation Deep Brain Stimulation - methods Drug Resistant Epilepsy - complications Drug Resistant Epilepsy - physiopathology Drug Resistant Epilepsy - therapy Female Focal seizures Hippocampus - physiopathology Humans Male Medically-intractable epilepsy Middle Aged Neocortex - physiopathology Periventricular nodular heterotopia (PVNH) Periventricular Nodular Heterotopia - complications Periventricular Nodular Heterotopia - physiopathology RNS® System |
| title | Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings |
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