Practical considerations in epilepsy neurostimulation

Epilepsia, Journal Year: 2022, Volume and Issue: 63(10), P. 2445 - 2460

Published: June 14, 2022

Neuromodulation is a key therapeutic tool for clinicians managing patients with drug-resistant epilepsy. Multiple devices are available long-term follow-up and real-world experience. The aim of this review to give practical summary neuromodulation techniques guide the selection modalities, focusing on patient devices, common approaches initiation programming, outpatient management issues. Vagus nerve stimulation (VNS), deep brain anterior nucleus thalamus (DBS-ANT), responsive neurostimulation (RNS) all supported by randomized controlled trials that show safety significant impact seizure reduction, as well suggestion reduction in risk sudden unexplained death epilepsy (SUDEP). Significant reductions observed after 3 months DBS, RNS, VNS trials, efficacy appears improve time out 7 10 years albeit uncontrolled or retrospective studies. A number experience seizure-free intervals 6 more three modalities. Number location epileptogenic foci important factors affecting efficacy, together comorbidities such severe mood sleep disorders, may influence choice modality. Programming has evolved-DBS typically initiated at lower current/voltage than used pivotal trial, whereas target charge density however generalizable optimal parameters yet be defined. Noninvasive an emerging modality, although it currently not widely. In summary, clinical practice evolved from those established trials. Guidance now who wish expand their approach, technique tailored individual based characteristics, tolerance, preferences.

Language: Английский

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Responsive neurostimulation with low‐frequency stimulation

Epilepsia, Journal Year: 2022, Volume and Issue: 64(2)

Published: Nov. 17, 2022

Abstract Deep brain stimulation and responsive neurostimulation (RNS) use high‐frequency (HFS) per the pivotal trials manufacturer‐recommended therapy protocols. However, not all patients respond to HFS. In this retrospective case series, 10 implanted with RNS System were programmed low‐frequency (LFS) treat their seizures; nine of these previously treated HFS (100 Hz or greater). LFS was defined as frequency < Hz. Burst duration increased at least 1000 ms. With HFS, had a median seizure reduction (MSR) 13% (interquartile range [IQR] = −67 54) after 19 months (IQR 8–49). contrast, associated 67% MSR 13–95) when compared 76% 43–91) baseline prior implantation. Charge delivered hour pulses day significantly different between LFS, although time stimulated longer for (228 min) than (7 min). There no LFS‐specific adverse effects reported by any patients. could represent an alternative, effective method delivering in focal drug‐resistant epilepsy System.

Language: Английский

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Closed-loop stimulation in periods with less epileptiform activity drives improved epilepsy outcomes

Brain, Journal Year: 2023, Volume and Issue: unknown

Published: Oct. 4, 2023

In patients with drug-resistant epilepsy, electrical stimulation of the brain in response to epileptiform activity can make seizures less frequent and debilitating. This therapy, known as closed-loop responsive neurostimulation (RNS), aims directly halt seizure via targeted a burgeoning seizure. Rather than immediately stopping they start, many RNS implants produce slower, long-lasting changes dynamics that better predict clinical outcomes. Here we hypothesize during states drives long-term restore healthy networks. To test this, quantified episodes low- high-risk states-that is, periods lower or higher risk generating activity-in cohort 40 treated RNS. More tonic low-risk out rhythmic predicted reduction. Additionally, events were more likely be phase-locked prolonged abnormal for intermediate poor responders when compared super-responders, consistent hypothesis improved outcomes are driven by states. These results support might underlie mechanisms RNS, suggesting relationship between temporal patterns neuromodulation plasticity facilitates

Language: Английский

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Seizure occurrence is linked to multiday cycles in diverse physiological signals

Epilepsia, Journal Year: 2023, Volume and Issue: 64(6), P. 1627 - 1639

Published: April 15, 2023

The factors that influence seizure timing are poorly understood, and unpredictability remains a major cause of disability. Work in chronobiology has shown cyclical physiological phenomena ubiquitous, with daily multiday cycles evident immune, endocrine, metabolic, neurological, cardiovascular function. Additionally, work chronic brain recordings identified risk is linked to activity. Here, we provide the first characterization relationships between modulation diverse set signals, activity, timing.In this cohort study, 14 subjects underwent ambulatory monitoring multimodal wrist-worn sensor (recording heart rate, accelerometry, electrodermal temperature) an implanted responsive neurostimulation system interictal epileptiform abnormalities electrographic seizures). Wavelet filter-Hilbert spectral analyses characterized circadian wearable recordings. Circular statistics assessed physiology.Ten met inclusion criteria. mean recording duration was 232 days. Seven had reliable electroencephalographic detections (mean = 76 Multiday were present all device signals across subjects. Seizure phase locked five (temperature), four (heart phasic activity), three (accelerometry, rate variability, tonic activity) Notably, after regression behavioral covariates from six seven locking residual signal.Seizure associated multiple processes. Chronic can situate rare paroxysmal events, like seizures, within broader context individual. Wearable devices may advance understanding enable personalized time-varying approaches epilepsy care.

Language: Английский

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Embedding digital chronotherapy into bioelectronic medicines

iScience, Journal Year: 2022, Volume and Issue: 25(4), P. 104028 - 104028

Published: March 4, 2022

Biological rhythms pervade physiology and pathophysiology across multiple timescales. Because of the limited sensing algorithm capabilities neuromodulation device technology to-date, insight into influence these on efficacy bioelectronic medicine has been infeasible. As development new devices begins to mitigate previous limitations, we propose that future should integrate chronobiological considerations in their control structures maximize benefits therapy. We motivate this proposition with preliminary longitudinal data recorded from patients Parkinson's disease epilepsy during deep brain stimulation therapy, where periodic symptom biomarkers are synchronized sub-daily, daily, longer timescale rhythms. suggest a physiological structure for incorporates time-based adaptation control, locked patient-specific biological rhythms, as an adjunct classical methods illustrate concept initial results three our recent case studies using chronotherapy-enabled prototypes.

Language: Английский

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Seizure forecasting: Bifurcations in the long and winding road

Epilepsia, Journal Year: 2022, Volume and Issue: 64(S4)

Published: May 23, 2022

To date, the unpredictability of seizures remains a source suffering for people with epilepsy, motivating decades research into methods to forecast seizures. Originally, only few scientists and neurologists ventured this niche endeavor, which, given difficulty task, soon turned long winding road. Over past decade, however, our narrow field has seen major acceleration, trials chronic electroencephalographic devices subsequent discovery cyclical patterns in occurrence Now, burgeoning science seizure timing is emerging, which turn informs best forecasting strategies upcoming clinical trials. Although finish line might be view, many challenges remain make reality. This review covers most recent scientific, technical, medical developments, discusses methodology detail, sets number goals future studies.

Language: Английский

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Emerging approaches in neurostimulation for epilepsy

Current Opinion in Neurology, Journal Year: 2023, Volume and Issue: unknown

Published: Feb. 8, 2023

Purpose of review Neurostimulation is a quickly growing treatment approach for epilepsy patients. We summarize recent approaches to provide perspective on the future neurostimulation. Recent findings Invasive stimulation focal includes vagus nerve stimulation, responsive neurostimulation cortex and deep brain anterior nucleus thalamus. A wide range other targets have been considered, including centromedian, central lateral pulvinar thalamic nuclei; medial septum, accumbens, subthalamic nucleus, cerebellum, fornicodorsocommissure piriform cortex. Stimulation generalized onset seizures mixed epilepsies as well increased efforts focusing paediatric populations emerged. Hardware with more permanently implanted lead options sensing capabilities emerging. wider variety programming than typically used may improve patient outcomes. Finally, noninvasive its favourable risk profile offers potential treat increasingly diverse Summary surprisingly varied. Flexibility reversibility allows rapid innovation. There remains continued need excitability biomarkers guide Neurostimulation, part bioelectronic medicine, distinctive benefits unique challenges.

Language: Английский

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Cyclical underreporting of seizures in patient‐based seizure documentation

Annals of Clinical and Translational Neurology, Journal Year: 2023, Volume and Issue: 10(10), P. 1863 - 1872

Published: Aug. 23, 2023

Circadian and multidien cycles of seizure occurrence are increasingly discussed as to their biological underpinnings in the context forecasting. This study analyzes if patient reported seizures provide valid data on such cyclical occurrence.We retrospectively studied circadian derived from patient-based reporting reflect objective documentation 2003 patients undergoing in-patient video-EEG monitoring.Only 24.1% more than 29000 documented were accompanied by notifications. There was underreporting with a maximum during nighttime, leading significant deviations distribution seizures. Significant found for focal epilepsies originating both, frontal temporal lobes, different types (in particular, unaware bilateral tonic-clonic seizures).Patient diaries may bias rather true distributions. Cyclical reports alone lead suboptimal treatment schemes, an underestimation seizure-associated risks, pose problems finding strongly supports use measures monitor distributions studies decisions based thereon.

Language: Английский

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Impedance Rhythms in Human Limbic System

Journal of Neuroscience, Journal Year: 2023, Volume and Issue: 43(39), P. 6653 - 6666

Published: Aug. 24, 2023

The impedance is a fundamental electrical property of brain tissue, playing crucial role in shaping the characteristics local field potentials, extent ephaptic coupling, and volume tissue activated by externally applied stimulation. We tracked impedance, sleep–wake behavioral state, epileptiform activity five people with epilepsy living their natural environment using an investigational device. study identified oscillations that span hours to weeks amygdala, hippocampus, anterior nucleus thalamus. these limbic regions exhibit multiscale cycles ultradian (∼1.5–1.7 h), circadian (∼21.6–26.4 infradian (∼20–33 d) periods. period are driven state transitions between wakefulness, nonrapid eye movement (NREM) sleep, rapid (REM) sleep. Limbic reaches minimum value NREM intermediate values REM rises through day during reaching maximum early evening before sleep onset. Infradian were not associated distinct correlate. Brain known strongly depend on extracellular space (ECS) volume, findings reported here consistent sleep–wake–dependent ECS changes recently observed rodent cortex related glymphatic system. hypothesize human underlie cycles. Impedance simple electrophysiological biomarker could prove useful for tracking dynamics health, disease, therapy. SIGNIFICANCE STATEMENT structures (amygdala, thalamus) shown over multiple timescales. observe periodicities NREM, states. There also spanning do have clear correlate whose origin remains unclear. These will impact ionic currents give rise approach measuring perturbational established engineering technique may be volume.

Language: Английский

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Resting-state background features demonstrate multidien cycles in long-term EEG device recordings

Brain stimulation, Journal Year: 2023, Volume and Issue: 16(6), P. 1709 - 1718

Published: Nov. 1, 2023

Longitudinal EEG recorded by implanted devices is critical for understanding and managing epilepsy. Recent research reports patient-specific, multi-day cycles in device-detected epileptiform events that coincide with increased likelihood of clinical seizures. Understanding these could elucidate mechanisms generating seizures advance drug neurostimulation therapies.

Language: Английский

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