Responsive Neurostimulation in Patients with a History of Viral Brain Infections – A Single Center Experience
Melissa Huynh Mabry1, Irina Podkorytova1, Kan Ding1, Alexander Doyle1, Jay Harvey1, Ryan Hays1, Bradley Lega1, Irfan Sheikh1, Ghazala Perven1
1University of Texas Southwestern Medical Center
Objective:
To evaluate seizure outcomes in patients with drug-resistant epilepsy (DRE) secondary to viral brain infections (VBI) who underwent treatment with responsive nerve stimulation (RNS).
Background:
Epilepsy secondary to VBI can be difficult to treat due to multifocal epileptogenicity. RNS has emerged as a closed-loop seizure treatment monitoring system particularly for patients who have multiple seizure foci that may not be amenable to resective surgery.
Design/Methods:
Patients with DRE secondary to VBI who were treated with RNS at our center were included. Nine patients met criteria. We compared seizure burden (defined by seizure frequency and severity) pre-implant and at the last follow-up in the context of pertinent risk factors and clinical characteristics.
Results:
Four out of 9 patients were responders to RNS therapy with >50% of seizure frequency reduction and average 39 month follow-up (range 8-84), and five patients were considered non-responders (<50% seizure reduction, average 47 month follow-up (range 10-98). Average age of VBI for responders was 24 years old (13-35) and for non-responders was 22 years old (2-36). Two responders had a destructive surgery prior to RNS placement. Four non-responders had a prior neurosurgical procedure including 1 focal resection, 2 vagus nerve stimulation, and 1 prior RNS. Patients in the responder group had shorter DRE duration before RNS placement than in the non-responder group (average 11.0 versus 14.4 years). Three responders and four non-responders had a history of focal to bilateral tonic clonic seizures (FBTC) pre-RNS. Post-RNS, 2 responder and 2 non-responders stopped experiencing FBTC with treatment.
Conclusions:
Our study demonstrated that RNS therapy could be effective in patients with DRE secondary to VBI even if the patients failed the previous surgical intervention(s). RNS therapy responders had shorter DRE duration prior to RNS placement than non-responders. Patients in both responder and non-responder groups had reduction of convulsive seizures.
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