Responsive neurostimulation as a treatment for super-refractory focal status epilepticus: a systematic review and case series.

Autor:	Ernst LD; Departments of1Neurology and., Raslan AM; 2Neurological Surgery, Oregon Health & Science University, Portland, Oregon., Wabulya A; 3Department of Neurology, University of North Carolina, Chapel Hill, North Carolina., Shin HW; 4Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico., Cash SS; 5Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts., Yang JC; 6Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio., Sagi V; 7Department of Neurology, University of Louisville, Kentucky., King-Stephens D; Departments of8Neurology and., Damisah EC; 9Neurological Surgery, Yale School of Medicine, New Haven, Connecticut., Ramos A; 10Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland., Hussain B; Departments of11Neurology and., Toprani S; Departments of11Neurology and., Brandman DM; 12Neurological Surgery, University of California, Davis, California., Shahlaie K; 12Neurological Surgery, University of California, Davis, California., Kanth K; Departments of11Neurology and., Arain A; 13Department of Neurology, University of Utah, Salt Lake City, Utah., Peters A; 13Department of Neurology, University of Utah, Salt Lake City, Utah., Rolston JD; 14Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts., Berns M; 15Department of Neurology, University of Minnesota, Minneapolis, Minnesota., Patel SI; 15Department of Neurology, University of Minnesota, Minneapolis, Minnesota., Uysal U; 16Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2023 Jun 09; Vol. 140 (1), pp. 201-209. Date of Electronic Publication: 2023 Jun 09 (Print Publication: 2024).
DOI:	10.3171/2023.4.JNS23367
Abstrakt:	Objective: Super-refractory status epilepticus (SRSE) has high rates of morbidity and mortality. Few published studies have investigated neurostimulation treatment options in the setting of SRSE. This systematic literature review and series of 10 cases investigated the safety and efficacy of implanting and activating the responsive neurostimulation (RNS) system acutely during SRSE and discusses the rationale for lead placement and selection of stimulation parameters. Methods: Through a literature search (of databases and American Epilepsy Society abstracts that were last searched on March 1, 2023) and direct contact with the manufacturer of the RNS system, 10 total cases were identified that utilized RNS acutely during SE (9 SRSE cases and 1 case of refractory SE [RSE]). Nine centers obtained IRB approval for retrospective chart review and completed data collection forms. A tenth case had published data from a case report that were referenced in this study. Data from the collection forms and the published case report were compiled in Excel. Results: All 10 cases presented with focal SE: 9 with SRSE and 1 with RSE. Etiology varied from known lesion (focal cortical dysplasia in 7 cases and recurrent meningioma in 1) to unknown (2 cases, with 1 presenting with new-onset refractory focal SE [NORSE]). Seven of 10 cases exited SRSE after RNS placement and activation, with a time frame ranging from 1 to 27 days. Two patients died of complications due to ongoing SRSE. Another patient's SE never resolved but was subclinical. One of 10 cases had a device-related significant adverse event (trace hemorrhage), which did not require intervention. There was 1 reported recurrence of SE after discharge among the cases in which SRSE resolved up to the defined endpoint. Conclusions: This case series offers preliminary evidence that RNS is a safe and potentially effective treatment option for SRSE in patients with 1-2 well-defined seizure-onset zone(s) who meet the eligibility criteria for RNS. The unique features of RNS offer multiple benefits in the SRSE setting, including real-time electrocorticography to supplement scalp EEG for monitoring SRSE progress and response to treatment, as well as numerous stimulation options. Further research is indicated to investigate the optimal stimulation settings in this unique clinical scenario.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu