Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings

George Nune, Sharanya Arcot Desai, Babak Razavi, Mark Agostini, Gregory K. Bergey, Aamr A. Herekar, Lawrence J. Hirsch, Ricky W. Lee, Paul A. Rutecki, Shraddha Srinivasan, Paul C. Van Ness, Thomas K. Tcheng, Martha J. Morrell

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1 Scopus citations

Abstract

Objectives: 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). Methods: 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. Results: 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. Conclusions: 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. Significance: 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.

Original languageEnglish (US)
Pages (from-to)1196-1207
Number of pages12
JournalClinical Neurophysiology
Volume130
Issue number8
DOIs
StatePublished - Aug 1 2019

Keywords

  • Brain-responsive neurostimulation
  • Focal seizures
  • Medically-intractable epilepsy
  • Periventricular nodular heterotopia (PVNH)
  • RNS® System

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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    Nune, G., Arcot Desai, S., Razavi, B., Agostini, M., Bergey, G. K., Herekar, A. A., Hirsch, L. J., Lee, R. W., Rutecki, P. A., Srinivasan, S., Van Ness, P. C., Tcheng, T. K., & Morrell, M. J. (2019). Treatment of drug-resistant epilepsy in patients with periventricular nodular heterotopia using RNS® System: Efficacy and description of chronic electrophysiological recordings. Clinical Neurophysiology, 130(8), 1196-1207. https://doi.org/10.1016/j.clinph.2019.04.706