Significant seizure frequency reduction in a patient with refractory bitemporal epilepsy following transition from high-frequency to low-frequency responsive neurostimulation

IF 1.5 Q3 CLINICAL NEUROLOGY
Stacey Kim , Christel Benny , Alan Salim , Charles Liu , Brian Lee , Hari Prasad Kunhi Veedu
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Abstract

While many patients treated with Responsive Neurostimulation (RNS) experience a significant reduction in seizures, poor responders to traditional high frequency stimulation (HFS) may experience a meaningful reduction in seizure frequency when switched to low frequency stimulation (LFS). This case report presents a patient who developed post-traumatic pharmacoresistant bitemporal epilepsy and underwent unsuccessful treatments, including antiseizure polytherapy and implantation of a vagus nerve stimulator (VNS). Due to ongoing seizures, the patient underwent RNS System implantation with bilateral hippocampal depth electrodes. Prior to RNS implantation, the patient experienced a median frequency of 6.5 seizures per month. At traditional HFS settings applied for 30 months, the patient experienced a 31 % reduction from baseline. After switching to LFS for 8 months, the patient experienced an 85 % reduction. HFS delivered 6.02 min per day, compared to 113.77 min per day with LFS. This patient experienced a substantial and meaningful reduction in seizure frequency after switching to LFS, suggesting that LFS may be an effective alternative for RNS patients who do not have a satisfactory seizure reduction to traditional HFS. Furthermore, this case report highlights the importance of collaboration between academic medical centers with public safety net hospitals in delivering advanced epilepsy care to people in underserved communities.
难治性双颞叶癫痫患者从高频反应性神经刺激过渡到低频反应性神经刺激后癫痫发作频率显著降低
虽然许多接受反应性神经刺激(RNS)治疗的患者癫痫发作次数显著减少,但对传统高频刺激(HFS)反应不良的患者在切换到低频刺激(LFS)后,癫痫发作次数可能会有显著减少。本病例报告介绍了一名创伤后耐药性双颞癫痫患者,并接受了不成功的治疗,包括抗癫痫综合治疗和迷走神经刺激器(VNS)的植入。由于持续发作,患者接受了双侧海马深度电极的RNS系统植入。在RNS植入之前,患者每月癫痫发作的中位数频率为6.5次。在传统的HFS设置下应用30个月,患者经历了31%的基线下降。在转换为LFS 8个月后,患者经历了85%的减少。HFS每天交付6.02分钟,而LFS每天交付113.77分钟。该患者在转换为LFS后癫痫发作频率显著降低,这表明LFS可能是RNS患者的有效替代方案,这些患者的癫痫发作减少程度低于传统HFS。此外,本病例报告强调了学术医疗中心与公共安全网医院之间的合作在向服务不足社区的人们提供先进的癫痫治疗方面的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Epilepsy and Behavior Reports
Epilepsy and Behavior Reports Medicine-Neurology (clinical)
CiteScore
2.70
自引率
13.30%
发文量
54
审稿时长
50 days
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