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Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy.

TitleNine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy.
Publication TypeJournal Article
Year of Publication2020
AuthorsNair DR, Laxer KD, Weber PB, Murro AM, Park YD, Barkley GL, Smith BJ, Gwinn RP, Doherty MJ, Noe KH, Zimmerman RS, Bergey GK, Anderson WS, Heck C, Liu CY, Lee RW, Sadler T, Duckrow RB, Hirsch LJ, Wharen RE, Tatum W, Srinivasan S, McKhann GM, Agostini MA, Alexopoulos AV, Jobst BC, Roberts DW, Salanova V, Witt TC, Cash SS, Cole AJ, Worrell GA, Lundstrom BN, Edwards JC, Halford JJ, Spencer DC, Ernst L, Skidmore CT, Sperling MR, Miller I, Geller EB, Berg MJ, A Fessler J, Rutecki P, Goldman AM, Mizrahi EM, Gross RE, Shields DC, Schwartz TH, Labar DR, Fountain NB, W Elias J, Olejniczak PW, Villemarette-Pittman NR, Eisenschenk S, Roper SN, Boggs JG, Courtney TA, Sun FT, Seale CG, Miller KL, Skarpaas TL, Morrell MJ
Corporate AuthorsRNS System LTT Study
JournalNeurology
Volume95
Issue9
Paginatione1244-e1256
Date Published2020 09 01
ISSN1526-632X
KeywordsAdolescent, Adult, Aged, Depressive Disorder, Drug Resistant Epilepsy, Electric Stimulation Therapy, Epilepsies, Partial, Female, Follow-Up Studies, Humans, Implantable Neurostimulators, Intracranial Hemorrhages, Male, Memory Disorders, Middle Aged, Prospective Studies, Prosthesis-Related Infections, Quality of Life, Randomized Controlled Trials as Topic, Status Epilepticus, Sudden Unexpected Death in Epilepsy, Suicide, Treatment Outcome, Young Adult
Abstract

OBJECTIVE: To prospectively evaluate safety and efficacy of brain-responsive neurostimulation in adults with medically intractable focal onset seizures (FOS) over 9 years.

METHODS: Adults treated with brain-responsive neurostimulation in 2-year feasibility or randomized controlled trials were enrolled in a long-term prospective open label trial (LTT) to assess safety, efficacy, and quality of life (QOL) over an additional 7 years. Safety was assessed as adverse events (AEs), efficacy as median percent change in seizure frequency and responder rate, and QOL with the Quality of Life in Epilepsy (QOLIE-89) inventory.

RESULTS: Of 256 patients treated in the initial trials, 230 participated in the LTT. At 9 years, the median percent reduction in seizure frequency was 75% ( < 0.0001, Wilcoxon signed rank), responder rate was 73%, and 35% had a ≥90% reduction in seizure frequency. We found that 18.4% (47 of 256) experienced ≥1 year of seizure freedom, with 62% (29 of 47) seizure-free at the last follow-up and an average seizure-free period of 3.2 years (range 1.04-9.6 years). Overall QOL and epilepsy-targeted and cognitive domains of QOLIE-89 remained significantly improved ( < 0.05). There were no serious AEs related to stimulation, and the sudden unexplained death in epilepsy (SUDEP) rate was significantly lower than predefined comparators ( < 0.05, 1-tailed χ).

CONCLUSIONS: Adjunctive brain-responsive neurostimulation provides significant and sustained reductions in the frequency of FOS with improved QOL. Stimulation was well tolerated; implantation-related AEs were typical of other neurostimulation devices; and SUDEP rates were low.

CLINICALTRIALSGOV IDENTIFIER: NCT00572195.

CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that brain-responsive neurostimulation significantly reduces focal seizures with acceptable safety over 9 years.

DOI10.1212/WNL.0000000000010154
Alternate JournalNeurology
PubMed ID32690786
PubMed Central IDPMC7538230