Owens Micaela R, Sather Michael, Fisher Tiffany L
Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States.
Front Neurol. 2023 Sep 22;14:1240380. doi: 10.3389/fneur.2023.1240380. eCollection 2023.
Responsive neurostimulation (RNS) is an implantable device for persons with medically refractory focal-onset epilepsy. We report a single-center experience for RNS outcomes with special focus on stereoelectroencephalography (sEEG) for seizure onset localization.
We performed retrospective review of patients with drug resistant focal epilepsy implanted with the RNS System for a minimum of six months between July 2014 and July 2019. Records were reviewed for demographic data, epilepsy duration, seizure frequency, number of prior antiepileptic drugs (AEDs), number of AEDs at RNS System implantation, prior epilepsy surgery or device use, previous seizure localization with sEEG, and RNS system information. Clinical response was defined as a 50% reduction in seizures. Differing response rates were calculated using Fisher Exact test.
30 patients met inclusion criteria. Seventeen (57%) underwent previous sEEG. Average clinical follow up was 3.0 years. Overall response rate was 70%. Median seizure reduction was 74.5%. Response rate was 82.3% for patients with sEEG compared to 53.8% without ( = 0.08); 37.5% for prior epilepsy surgery compared to 81.8% without ( = 0.02); 70% for mesial temporal onset; 50% for previous vagal nerve stimulator compared to 77.3% without ( = 0.13).
Our response rates match or surpass outcome metrics of previous studies. Although limited by small study size, subpopulation analyses show positive response rates in patients with previous sEEG versus no sEEG and in temporal versus extratemporal pathology. Additional research is needed to evaluate efficacy of RNS in patients with previous epilepsy surgery, and utility of sEEG in this population.
响应性神经刺激（RNS）是一种用于药物难治性局灶性癫痫患者的可植入设备。我们报告了单中心RNS治疗结果的经验，特别关注用于癫痫发作起始定位的立体脑电图（sEEG）。
我们对2014年7月至2019年7月期间植入RNS系统至少6个月的药物难治性局灶性癫痫患者进行了回顾性研究。查阅记录以获取人口统计学数据、癫痫病程、发作频率、先前抗癫痫药物（AED）的数量、RNS系统植入时AED的数量、先前的癫痫手术或设备使用情况、先前通过sEEG进行的癫痫发作定位以及RNS系统信息。临床反应定义为发作减少50%。使用Fisher精确检验计算不同的反应率。
30例患者符合纳入标准。17例（57%）曾接受过sEEG检查。平均临床随访时间为3.0年。总体反应率为70%。发作减少的中位数为74.5%。接受sEEG检查的患者反应率为82.3%，未接受sEEG检查的患者为53.8%（P = 0.08）；先前接受癫痫手术的患者为37.5%，未接受癫痫手术的患者为81.8%（P = 0.02）；颞叶内侧发作的患者为70%；先前使用迷走神经刺激器的患者为50%，未使用的患者为77.3%（P = 0.13）。
我们的反应率与先前研究的结果指标相匹配或超过。尽管受研究规模小的限制，但亚组分析显示，与未接受sEEG检查的患者相比，接受过sEEG检查的患者以及颞叶病变与颞叶外病变的患者有阳性反应率。需要进一步研究来评估RNS在先前接受癫痫手术的患者中的疗效以及sEEG在该人群中的实用性。
