Two new studies offer long-term perspective on the efficacy and safety of brain responsive neuromodulation for the reduction of seizures. One study evaluated the effects of NeuroPace’s RNS System in patients with medically intractable mesial temporal lobe epilepsy (Epilepsia. 2017 Apr 11), while the other looked at its effects on patients with medically intractable seizures arising from eloquent and other neocortical areas (Epilepsia. 2017 Apr 7). In the latter study, the median reduction in seizure frequency was 51 percent to 70 percent at six years. Moreover, 26 percent of patients experienced at least one seizure-free period at six month or longer, and 14 percent experienced at least one seizure-free period of one year or longer.
“These studies suggest that the RNS device is a significant addition in the treatment of epilepsy for patients who did not have a surgical option previously,” said lead author Barbara C. Jobst, MD in an interview. While patients are generally under-referred for surgical treatment, a significant portion of these patients is not eligible for surgery, Dr. Jobst noted. “For many patients there are limitations for surgery, such as those who would have deficit if we removed the seizure focus, or others who have more than one seizure focus or who may have significant memory deficit.” In these patients, the RNS device may be particularly beneficial. “You can implant the device in seizure onset zones, even if there are more than one. You can also implant it in areas that in the past we would consider in ‘eloquent’ areas of the brain.” These include areas that control language and motor skills, which Dr. Jobst noted would not be interrupted by the device.
According to Dr. Jobst, the RNS device is another valuable treatment tool in high-level epilepsy care that bolsters the profile of surgical epilepsy care. She further observed that many patients are still not receiving the advanced treatment they may require. “A lot of patients continue to have seizures are on medications that don’t get sent to comprehensive epilepsy center; this is a problem that has plagued our community for a long time.” Nevertheless, she is hopeful that continued awareness for devices such as RNS and a growing platform of surgical interventions will compel physicians to make the appropriate referrals. “The goal is 100 percent seizure freedom,” said Dr. Jobst. “If someone has intractable epilepsy, consider a referral to a comprehensive epilepsy center for surgical evaluation.”Next Story