Mood and quality of life in patients treated with brain-responsive neurostimulation: The value of earlier intervention

David W Loring,Beata Jarosiewicz,Kimford J Meador,Andres M Kanner,Tara L Skarpaas,Martha J Morrell

doi:10.1016/j.yebeh.2021.107868

Abstract

ObjectiveTo establish whether earlier treatment using direct brain-responsive neurostimulation for medically intractable focal-onset seizures is associated with better mood and Quality of Life (QoL) compared to later treatment intervention. MethodsData were retrospectively analyzed from prospective clinical trials of a direct brain-responsive neurostimulator (RNS® System) for treatment of adults with medically intractable focal-onset epilepsy. Participants completed the Quality of Life in Epilepsy Inventory (QOLIE-31) yearly through 9 years of follow-up and the Beck Depression Inventory-II (BDI-II) through 2 years of follow-up. Changes in each assessment after treatment with responsive neurostimulation were calculated for patients who began treatment within 10 years of seizure onset (early) and those who began treatment 20 years or more after seizure onset (late). ResultsThe median duration of epilepsy was 18.3 years at enrollment. At 9 years, both the early (N = 51) and late (N = 109) treatment groups experienced similar and significant reductions in the frequency of disabling seizures (73.4% and 77.8%, respectively). The early treatment patients had significant improvements in QoL and mood. However, the late treatment patients not only failed to show these improvements but also declined in the emotional QoL subscale. ConclusionsPatients treated with brain-responsive neurostimulation earlier in the course of their epilepsy show significant improvements in multiple domains of QoL and mood that are not observed in patients treated later in the course of their epilepsy despite similar efficacy in seizure reduction. Even with similar and substantial reductions in seizure frequency, the comorbidities of uncontrolled epilepsy may be less responsive to treatment when too many years have passed. The results of this study suggest that, as with resective and ablative surgery, treatment with brain-responsive neurostimulation should be delivered as early as possible in the course of medically resistant epilepsy to maximize the opportunity for improvements in mood and QoL.

Highlights

Epilepsy is one of the most common neurological disorders, afflicting approximately 1% of the population [1,2,3]
There were 145 patients who completed the Beck Depression Inventory-II (BDI-II) at baseline and 2 years (27 early and 70 late) and 145 patients who completed the QOLIE-31 at both baseline and 9 years (32 early and 72 late)
Vs. late groups differed in their treatment-related changes in QOLIE-31 and BDI-II scores

Summary

Introduction

Epilepsy is one of the most common neurological disorders, afflicting approximately 1% of the population [1,2,3]. ⇑ Corresponding author at: Emory University Brain Health Center, 12 Executive medications (ASMs) fail to control seizures in about 40% of patients with focal-onset epilepsy [4]. Treatment options for ASM-resistant epilepsy include surgery to resect or ablate the seizure focus and neuromodulation therapies. Surgical resection or ablation of the seizure focus is the preferred treatment option for patients with medically refractory seizures, whose seizure focus can be localized and the planned resection would not involve an eloquent brain area [6,7,8,9,10].

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Conclusion