Chronic subthreshold cortical stimulation for adult drug-resistant focal epilepsy: Safety, feasibility, and technique

Panagiotis Kerezoudis, Sanjeet S. Grewal, Squire Matthew Stead, Brian Nils Lundstrom, Jeffrey W. Britton, Cheolsu Shin, Gregory D Cascino, Benjamin Brinkmann, Gregory Alan Worrell, Jamie Van Gompel

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

OBJECTIVE Epilepsy surgery is effective for lesional epilepsy, but it can be associated with significant morbidity when seizures originate from eloquent cortex that is resected. Here, the objective was to describe chronic subthreshold cortical stimulation and evaluate its early surgical safety profile in adult patients with epilepsy originating from seizure foci in cortex that is not amenable to resection. METHODS Adult patients with focal drug-resistant epilepsy underwent intracranial electroencephalography monitoring for evaluation of resection. Those with seizure foci in eloquent cortex were not candidates for resection and were offered a short therapeutic trial of continuous subthreshold cortical stimulation via intracranial monitoring electrodes. After a successful trial, electrodes were explanted and permanent stimulation hardware was implanted. RESULTS Ten patients (6 males) who underwent chronic subthreshold cortical stimulation between 2014 and 2016 were included. Based on radiographic imaging, intracranial pathologies included cortical dysplasia (n = 3), encephalomalacia (n = 3), cortical tubers (n = 1), Rasmussen encephalitis (n = 1), and linear migrational anomaly (n = 1). The duration of intracranial monitoring ranged from 3 to 20 days. All patients experienced an uneventful postoperative course and were discharged home with a median length of stay of 10 days. No postoperative surgical complications developed (median follow-up length 7.7 months). Seizure severity and seizure frequency improved in all patients. CONCLUSIONS The authors’ institutional experience with this small group shows that chronic subthreshold cortical stimulation can be safely and effectively performed in appropriately selected patients without postoperative complications. Future investigation will provide further insight to recently published results regarding mechanism and efficacy of this novel and promising intervention.

Original languageEnglish (US)
Pages (from-to)533-543
Number of pages11
JournalJournal of Neurosurgery
Volume129
Issue number2
DOIs
StatePublished - Aug 1 2018

Fingerprint

Partial Epilepsy
Seizures
Safety
Epilepsy
Electrodes
Encephalomalacia
Malformations of Cortical Development
Encephalitis
Drug Resistant Epilepsy
Length of Stay
Pathology
Morbidity

Keywords

  • Cortical electrodes
  • Cortical stimulation
  • Intractable epilepsy
  • Medically refractory epilepsy
  • Surgical technique

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Chronic subthreshold cortical stimulation for adult drug-resistant focal epilepsy : Safety, feasibility, and technique. / Kerezoudis, Panagiotis; Grewal, Sanjeet S.; Stead, Squire Matthew; Lundstrom, Brian Nils; Britton, Jeffrey W.; Shin, Cheolsu; Cascino, Gregory D; Brinkmann, Benjamin; Worrell, Gregory Alan; Van Gompel, Jamie.

In: Journal of Neurosurgery, Vol. 129, No. 2, 01.08.2018, p. 533-543.

Research output: Contribution to journalArticle

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