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Dual responsive neurostimulation implants for epilepsy

Barbaro, Michael F. and Chesney, Kelsi and Kramer, Daniel R. and Kellis, Spencer and Peng, Terrance and Blumenfeld, Zack and Gogia, Angad S. and Lee, Morgan B. and Greenwood, Janet and Nune, George and Kalayjian, Laura A. and Heck, Christianne N. and Liu, Charles Y. and Lee, Brian (2019) Dual responsive neurostimulation implants for epilepsy. Journal of Neurosurgery . ISSN 0022-3085. (In Press) http://resolver.caltech.edu/CaltechAUTHORS:20190211-102326986

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Abstract

Closed-loop brain-responsive neurostimulation via the RNS System is a treatment option for adults with medically refractory focal epilepsy. Using a novel technique, 2 RNS Systems (2 neurostimulators and 4 leads) were successfully implanted in a single patient with bilateral parietal epileptogenic zones. In patients with multiple epileptogenic zones, this technique allows for additional treatment options. Implantation can be done successfully, without telemetry interference, using proper surgical planning and neurostimulator positioning. Trajectories for the depth leads were planned using neuronavigation with CT and MR imaging. Stereotactic frames were used for coordinate targeting. Each neurostimulator was positioned with maximal spacing to avoid telemetry interference while minimizing patient discomfort. A separate J-shaped incision was used for each neurostimulator to allow for compartmentalization in case of infection. In order to minimize surgical time and risk of infection, the neurostimulators were implanted in 2 separate surgeries, approximately 3 weeks apart. The neurostimulators and leads were successfully implanted without adverse surgical outcomes. The patient recovered uneventfully, and the early therapy settings over several months resulted in preliminary decreases in aura and seizure frequency. Stimulation by one of the neurostimulators did not result in stimulation artifacts detected by the contralateral neurostimulator.


Item Type:Article
Related URLs:
URLURL TypeDescription
https://doi.org/10.3171/2018.8.JNS181362DOIArticle
https://thejns.org/view/journals/j-neurosurg/aop/article-10.3171-2018.8.JNS181362.xmlPublisherArticle
ORCID:
AuthorORCID
Kramer, Daniel R.0000-0003-4551-2977
Kellis, Spencer0000-0002-5158-1058
Additional Information:© 2019 American Association of Neurological Surgeons.
Record Number:CaltechAUTHORS:20190211-102326986
Persistent URL:http://resolver.caltech.edu/CaltechAUTHORS:20190211-102326986
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:92829
Collection:CaltechAUTHORS
Deposited By: Tony Diaz
Deposited On:12 Feb 2019 22:17
Last Modified:12 Feb 2019 22:17

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