Neurostimulation

Question 1

What are the responsive neurostimulation modalities?

Answer 1

VNS, thalamus stimulation

Question 2

Are there differences in seizure reduction with the devices of responsive neurostimulation?

Answer 2

No

Question 3

How does the reduction in seizure frequency in responsive neurostimulation compare to trials of adjunctive therapy?

Answer 3

Same range of reduction

Question 4

Is seizure freedom common with responsive neurostimulation?

Answer 4

No, very few patients become seizure free.

Question 5

What is responsive neurostimulation?

Answer 5

This mechanism senses electrographic activity and then provides stimulation.

Question 6

How does anterior thalamus deep brain stimulation function?

Answer 6

Works by providing stimulation at a constant time interval.

Question 7

Responsive neurostimulation and anterior thalamus deep brain stimulation have what evidence of effectiveness?

Answer 7

Class I

Question 8

VNS side effect of intermittent hoarseness, is it pernmanent?

Answer 8

No usually temporary. This is seen in 47-66% of cases

Question 9

What is the most common side effect of stimulation of the anterior thalamus?

Answer 9

Depression in 15%

Question 10

What are other common side effects of anterior thalamus stimulation?

Answer 10

Memory impairment in 13%, confusion in 9% and site infection in 12%

Question 11

VNS can be beneficial in multiple seizure types, but the most benefit is likely best in what type of seizures? What

Answer 11

Temporal lobe epilepsy

Question 12

Responsive neurostimulation can be used with known seizure onset of how many areas?

Answer 12

No more than 2 cortical areas

Question 13

What is the seizure reduction of RNS?

Answer 13

38% over sham, long term median seizure reduction of 53%

Question 14

What is the reduction of epilepsy of right medial temporal sclerosis?

Answer 14

60-80% reduction

Question 15

What is the reason RNS is not approved for children?

Answer 15

The device is implanted in the skull and skull growth would interfere

Question 16

What is closed loop stimulation?

Answer 16

Stimulation delivered when epileptiform activity is detected

Question 17

What is the only FDA approved closed loop stimulation used to treat refractory epilepsy?

Answer 17

Neuropace device

Question 18

What is the frequency used in RNS?

Answer 18

100 - 200 Hz

Question 19

What is the average seizure frequency reduction using RNS?

Answer 19

After 6 years there is a 60% reduction. After 2years it is about 53%

Question 20

Has RNS been associated with depression?

Answer 20

No, unlike deep brain stimulation

Question 21

What adverse side effect is neurostimulation more common then medication?

Answer 21

Paresthesias, at the stimulation or sometimes at distal lead sites.

Question 22

What is the length of transacted VNS lead remaining in the body that the FDA allows an MRI

Answer 22

2 cm remaining attached to the nerve

Question 23

Why is the anterior nucleus of the thalamus the target for deep brain stimulation?

Answer 23

It is a key junction in the Papez circuit, which is thought to propagate seizures involving the medial temporal or medial frontal region