Responsive neurostimulation as a treatment for super-refractory focal status epilepticus: a systematic review and case series

医学 神经刺激 癫痫持续状态 耐火材料(行星科学) 不利影响 儿科 癫痫 外科 内科学 精神科 刺激 天体生物学 物理
作者
Lia Ernst,Ahmed M. Raslan,Angela Wabulya,Hae Won Shin,Sydney S. Cash,Jimmy C. Yang,Vishwanath Sagi,David King-Stephens,Eyiyemisi Damisah,Alexander Ramos,Batool Hussain,Sheela Toprani,David M. Brandman,Kiarash Shahlaie,Kiran Kanth,Amir Arain,Angela Peters,John D. Rolston,Meaghan Berns,Sana Patel,Utku Uysal
出处
期刊:Journal of Neurosurgery [Journal of Neurosurgery Publishing Group]
卷期号:: 1-9 被引量:2
标识
DOI:10.3171/2023.4.jns23367
摘要

OBJECTIVE Super-refractory status epilepticus (SRSE) has high rates of morbidity and mortality. Few published studies have investigated neurostimulation treatment options in the setting of SRSE. This systematic literature review and series of 10 cases investigated the safety and efficacy of implanting and activating the responsive neurostimulation (RNS) system acutely during SRSE and discusses the rationale for lead placement and selection of stimulation parameters. METHODS Through a literature search (of databases and American Epilepsy Society abstracts that were last searched on March 1, 2023) and direct contact with the manufacturer of the RNS system, 10 total cases were identified that utilized RNS acutely during SE (9 SRSE cases and 1 case of refractory SE [RSE]). Nine centers obtained IRB approval for retrospective chart review and completed data collection forms. A tenth case had published data from a case report that were referenced in this study. Data from the collection forms and the published case report were compiled in Excel. RESULTS All 10 cases presented with focal SE: 9 with SRSE and 1 with RSE. Etiology varied from known lesion (focal cortical dysplasia in 7 cases and recurrent meningioma in 1) to unknown (2 cases, with 1 presenting with new-onset refractory focal SE [NORSE]). Seven of 10 cases exited SRSE after RNS placement and activation, with a time frame ranging from 1 to 27 days. Two patients died of complications due to ongoing SRSE. Another patient’s SE never resolved but was subclinical. One of 10 cases had a device-related significant adverse event (trace hemorrhage), which did not require intervention. There was 1 reported recurrence of SE after discharge among the cases in which SRSE resolved up to the defined endpoint. CONCLUSIONS This case series offers preliminary evidence that RNS is a safe and potentially effective treatment option for SRSE in patients with 1–2 well-defined seizure-onset zone(s) who meet the eligibility criteria for RNS. The unique features of RNS offer multiple benefits in the SRSE setting, including real-time electrocorticography to supplement scalp EEG for monitoring SRSE progress and response to treatment, as well as numerous stimulation options. Further research is indicated to investigate the optimal stimulation settings in this unique clinical scenario.
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