Thalamic neuromodulation outcomes in drug-resistant refractory epilepsy with Deep Brain Stimulation and Responsive Neurostimulation (P5-1.003)

Abstract

<h3>Objective:</h3> We aim to compare effects of thalamic Deep Brain Stimulator (DBS) and responsive neurostimulator (RNS) device therapy on seizure burden in drug-resistant epilepsy patients. <h3>Background:</h3> Intractable epilepsy unamenable to cortical resection is often treated with a device, either RNS or DBS provides intracranial stimulation. The devices are thought to reduce seizure frequency by reducing synchronization of cortical activity. The RNS provides more localized stimulation while the DBS does this by stimulating the anterior nucleus of the thalamus. At our institution a small number of patients have also undergone thalamic stimulation by using the RNS. <h3>Design/Methods:</h3> We performed retrospective analysis on seizure frequency pre-implant and at most recent follow-up for our cohort, 12 DBS and 6 RNS patients. <h3>Results:</h3> Average age of RNS implantation was 30 years (range 19–41) vs 42 years (range 18–66) for DBS. Thirteen (9 DBS, 4 RNS) of the 18 patients had stereo-EEG (SEEG) evaluation before device placement, SEEG ictal onset was broad or multifocal in all (DBS: 7 – bilateral and 2 – unilateral, RNS: 3 bilateral, 1 unilateral). Three out of five patients who did not have invasive EEG evaluation before device placement had suspected (2) or confirmed (1) genetic etiology, all five had non-localizing, non-lateralizing scalp ictal EEG. The electrodes were placed to the anterior nucleus of thalamus bilaterally in all DBS and four RNS patients, two RNS patients had centromedian nucleus of thalamus sampling. Twelve of our 18 patients (8 out of 12 DBS and 4 out of 6 RNS) were shown to be responders, achieving 50% or greater reduction in seizure frequency. The average follow-up duration for RNS was 22 months (range 3–36), for DBS 13.5 months (range 2–29). <h3>Conclusions:</h3> This analysis demonstrates the potency of thalamic neuromodulation, both RNS and DBS, as therapies capable of seizure relief in wide breadths of epilepsy presentations. <b>Disclosure:</b> Dr. Das has received personal compensation for serving as an employee of Concentra. Dr. Das has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for janicek. The institution of an immediate family member of Dr. Das has received research support from NIH. irina podkorytova has nothing to disclose. Chijindu Iheanacho has nothing to disclose. Dr. Alick-Lindstrom has nothing to disclose. Dr. Agostini has nothing to disclose. Dr. Doyle has nothing to disclose. The institution of Dr. Ding has received research support from National Institute of Aging. The institution of Dr. Ding has received research support from NINDS. Dr. Hays has nothing to disclose. Dr. Perven has nothing to disclose. Dr. Dieppa has nothing to disclose. Dr. Zepeda Garcia has nothing to disclose.