Neurostimulation Flashcards
What are the responsive neurostimulation modalities?
VNS, thalamus stimulation
Are there differences in seizure reduction with the devices of responsive neurostimulation?
No
How does the reduction in seizure frequency in responsive neurostimulation compare to trials of adjunctive therapy?
Same range of reduction
Is seizure freedom common with responsive neurostimulation?
No, very few patients become seizure free.
What is responsive neurostimulation?
This mechanism senses electrographic activity and then provides stimulation.
How does anterior thalamus deep brain stimulation function?
Works by providing stimulation at a constant time interval.
Responsive neurostimulation and anterior thalamus deep brain stimulation have what evidence of effectiveness?
Class I
VNS side effect of intermittent hoarseness, is it pernmanent?
No usually temporary. This is seen in 47-66% of cases
What is the most common side effect of stimulation of the anterior thalamus?
Depression in 15%
What are other common side effects of anterior thalamus stimulation?
Memory impairment in 13%, confusion in 9% and site infection in 12%
VNS can be beneficial in multiple seizure types, but the most benefit is likely best in what type of seizures? What
Temporal lobe epilepsy
Responsive neurostimulation can be used with known seizure onset of how many areas?
No more than 2 cortical areas
What is the seizure reduction of RNS?
38% over sham, long term median seizure reduction of 53%
What is the reduction of epilepsy of right medial temporal sclerosis?
60-80% reduction
What is the reason RNS is not approved for children?
The device is implanted in the skull and skull growth would interfere
What is closed loop stimulation?
Stimulation delivered when epileptiform activity is detected
What is the only FDA approved closed loop stimulation used to treat refractory epilepsy?
Neuropace device
What is the frequency used in RNS?
100 - 200 Hz
What is the average seizure frequency reduction using RNS?
After 6 years there is a 60% reduction. After 2years it is about 53%
Has RNS been associated with depression?
No, unlike deep brain stimulation
What adverse side effect is neurostimulation more common then medication?
Paresthesias, at the stimulation or sometimes at distal lead sites.
What is the length of transacted VNS lead remaining in the body that the FDA allows an MRI
2 cm remaining attached to the nerve
Why is the anterior nucleus of the thalamus the target for deep brain stimulation?
It is a key junction in the Papez circuit, which is thought to propagate seizures involving the medial temporal or medial frontal region
