Transcript Imaging - Epilepsy Foundation of Greater Chicago

The NeuroPace RNS® System and
Surgical Options
Ryan B. Kochanski, MD
Clinical Fellow in Functional and Epilepsy Surgery
Rush University Medical Center
Sepehr Sani, MD
Assistant Professor
Rush University Medical Center
November 12, 2016
Disclosures
• None
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Objectives
• Provide an overview of the RNS system
• Discuss indications for implantation
• Describe the surgical procedure
• Discuss long term outcome data
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NeuroPace RNS® System
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What is Responsive Neurostimulation?
• Two major functions that
comprise the device:
– Recording of brain wave
activity i.e. long term EEG
recording
– Electrical stimulation at the
location of the implanted
electrode to abort a seizure
when it is detected
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Continuous Long Term Recording
• The device continuously
records and stores the
electrophysiological
information from the
electrode(s) (EEG data)
• This stored data can be then
transferred to an online
Patient Data Management
System using the interrogating
device
• Physicians can access and
analyze this information
remotely
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Stimulation
• The device can be
programmed to deliver an
electrical stimulus when
seizure activity is
recognized in order to
“break” the seizure
• Stimulation settings can be
adjusted by the physician
depending on response
• Different than VNS which
provides non-selective
stimulation
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Indications for Surgery
• 18 years of age or older
• Poor seizure control despite 2 or more antiseizure medications
• Frequent and disabling partial onset seizures
localized to 2 or less foci based on preoperative
testing
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Pre-Operative Planning
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An MRI of the brain is obtained as an outpatient
On the day of surgery, a head frame is placed on the patient and a CT scan is obtained
The MRI and CT scan are then merged using a planning software
The planning software is used to create a surgical plan for the placement of the lead(s)
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Surgery
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Surgery – Battery placement
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Case Illustration
• 25 year old male with a history of epilepsy since childhood who underwent a
left temporal lobectomy in ‘03 and left vagal nerve stimulator placement in
‘06
• Seizures are characterized by loss of awareness and arrest of activity, where
he suddenly stops and stands still followed by hand shaking or finger tapping.
• EEG – Continuous, irregular, right greater than left temporal slow wave
activity with occasional epileptiform discharges on the right and left.
• Findings suggestive of bilateral temporal epilepsy.
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Surgical Plan
Bilateral Parahippocampal Depth Leads
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Post-Operative Imaging
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Surgical Complications
Bergey et al. Neurology. 2016
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Long term outcomes
Bergey et al. Neurology. 2016
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C.U.R.E.
• Continuous recording and storage of EEG data can allow for better
localization of seizure activity
• With better seizure localization, some patients who were initially not thought to
be candidates for resective surgery have become surgical candidates
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Q&A
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References
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Bergey GK, Morrell MJ, Mizrahi EM, Goldman A, King-Stephens D, Nair D, et al.:
Long-term treatment with responsive brain stimulation in adults with refractory
partial seizures. Neurology 2015 Feb 24;84:810–817.
DiLorenzo DJ, Mangubat EZ, Rossi MA, Byrne RW: Chronic unlimited recording
electrocorticography-guided resective epilepsy surgery: technology-enabled enhanced
fidelity in seizure focus localization with improved surgical efficacy. J Neurosurg 2014
Jun;120:1402–1414.
Heck CN, King-Stephens D, Massey AD, Nair DR, Jobst BC, Barkley GL, et al.: Twoyear seizure reduction in adults with medically intractable partial onset epilepsy
treated with responsive neurostimulation: final results of the RNS System Pivotal trial.
Epilepsia 2014 Mar;55:432–441.
Morrell MJ, RNS System in Epilepsy Study Group: Responsive cortical stimulation
for the treatment of medically intractable partial epilepsy. Neurology 2011 Sep
27;77:1295–1304.
Sun FT, Morrell MJ: The RNS System: responsive cortical stimulation for the
treatment of refractory partial epilepsy. Expert Rev Med Devices 2014 Nov;11:563–
572.
Thomas GP, Jobst BC: Critical review of the responsive neurostimulator system for
epilepsy. Med Devices (Auckl) 2015 Oct 1;8:405–411.
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