Surgical resection and LiTT are standard treatments for refractory epilepsy, but these options can be limited by eloquent cortex and seizure multifocality. Previous studies have suggested RNS may be used in conjunction with resective surgery (RNS+R) or LiTT (RNS+LiTT) as a new combination of treatments. Besides seizure control, quality of life and psychiatric symptoms including depression and anxiety are considered as important outcome evaluation after epilepsy surgery.

34 patients that had RNS+R or RNS+LiTT at our center were reviewed and 10 were excluded. The decision of dual procedures was made prior to surgery. Patients received RNS+R had both resective surgery and RNS placement in the same procedure. Patients received RNS+LiTT had several weeks gap between the RNS placement and LiTT due to neurosurgical logistics. Clinical follow-ups were performed at 12, 18, 24, 36 and 48 months for evaluation of seizure frequency. Patient health questionnaire-9 (PHQ-9) is used as a depression assessment. Quality of life in epilepsy questionnaire (QOLIE-31) was used as scoring for evaluation of general quality of life.  

Among the 24 patients that had RNS+R or RNS+LiTT, 22 patients (91.6%) showed improved seizure frequency at the last follow up. Fourteen patients had PHQ-9 evaluation and the average score was 5.85±6.29 (mean±SD), among which nine were between 0-4 (minimal depression), one was between 5-9(mild depression), three were between 10-14(moderate depression), one was 15-19(moderately severe depression) and none was 20-27(severe depression). QOLIE-31 done in eight patients showed average score of 65.61 ± 18.09 (mean±SD) in last follow-up visit.

Our study showed significant seizure control rate of RNS+R or RNS+LiTT therapy in refractory epilepsy patients. It also suggestive for promising psychiatric outcomes and quality of life scoring after surgery.