Abstract
ObjectiveNeurostimulation devices that deliver electrical impulses to the nervous system are widely used to treat seizures in patients with medically refractory epilepsy, but the effects of these therapies on sleep are incompletely understood. Vagus nerve stimulation can contribute to obstructive sleep apnea, and thalamic deep brain stimulation can cause sleep disruption. A device for brain‐responsive neurostimulation (RNS® System, NeuroPace, Inc) is well tolerated in clinical trials, but potential effects on sleep are unknown.MethodsSix adults with medically refractory focal epilepsy treated for at least six months with the RNS System underwent a single night of polysomnography (PSG). RNS System lead locations included mesial temporal and neocortical targets. Sleep stages and arousals were scored according to standard guidelines. Stimulations delivered by the RNS System in response to detections of epileptiform activity were identified by artifacts on scalp electroencephalography.ResultsOne subject was excluded for technical reasons related to unreliable identification of stimulation artifact on EEG during PSG. In the remaining five subjects, PSG showed fragmented sleep with frequent arousals. Arousal histograms aligned to stimulations revealed a significant peak in arousals just before stimulation. In one of these subjects, the arousal peak began before stimulation and extended ~1 seconds after stimulation. A peak in arousals occurring only after stimulation was not observed.SignificanceIn this small cohort of patients, brain‐responsive neurostimulation does not appear to disrupt sleep. If confirmed in larger studies, this could represent a potential clinical advantage of brain‐responsive neurostimulation over other neurostimulation modalities.
Highlights
Patients with drug-resistant epilepsy[1] who are not candidates for resective surgery[2] may benefit from implanted neurostimulation devices—vagus nerve stimulation (VNS), thalamic deep brain stimulation (DBS), or brain-responsive neurostimulation (RNS System)—adjunctive palliative treatments that can reduce seizures over time.[3,4] The advent of these three FDAapproved devices has made neurostimulation for epilepsy a burgeoning field.[5]
By obtaining PSG in a small cohort of subjects implanted with the RNS System, we provide evidence that brain-responsive neurostimulation of neocortical and mesial temporal targets does not disrupt sleep
Across subjects with diverse epilepsies and wide-ranging rates of stimulation, we found that the distribution of arousals typically peaks just before, rather than after, stimulation
Summary
Patients with drug-resistant epilepsy[1] who are not candidates for resective surgery[2] may benefit from implanted neurostimulation devices—vagus nerve stimulation (VNS), thalamic deep brain stimulation (DBS), or brain-responsive neurostimulation (RNS System)—adjunctive palliative treatments that can reduce seizures over time.[3,4] The advent of these three FDAapproved devices has made neurostimulation for epilepsy a burgeoning field.[5]. Patients with drug-resistant epilepsy[1] who are not candidates for resective surgery[2] may benefit from implanted neurostimulation devices—vagus nerve stimulation (VNS), thalamic deep brain stimulation (DBS), or brain-responsive neurostimulation (RNS System)—adjunctive palliative treatments that can reduce seizures over time.[3,4]. The advent of these three FDAapproved devices has made neurostimulation for epilepsy a burgeoning field.[5]. Median reduction in seizure frequency with brain-responsive neurostimulation reaches 75%,16 and the therapeutic mechanism is thought to involve, in part, desynchronization of high-frequency cortical rhythms.[17] Whether this desynchronization affects sleep, which is dominated by slower, synchronized frequencies, remains unknown. Arousal histograms aligned to stimulations were used to examine the temporal relationship between arousals and stimulations to test whether brain-responsive neurostimulation disrupts sleep
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