Abstract Details

Title Comparison of Responsive Neurostimulation System Efficacy Between Different Electrographic Seizure Onset Patterns

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S31 - Epilepsy/Clinical Neurophysiology (EEG) 3 (4:54 PM-5:06 PM)

Poster/Presentation
Number 008

Objective Define predominant seizure onset patterns (SOP) on electrocorticography recordings (ECoGs) of Responsive Neurostimulation System (RNS)–implanted patients and determine their impact on response to neurostimulation.

Background About 1/3 of epilepsy patients are refractory to antiepileptic drugs alone. For those with focal onset seizures, RNS may represent a beneficial adjunctive therapy. This device can detect and interrupt seizure-like activity with focal stimulation. Although seizure reduction in RNS patients seems unrelated to prior interventions or location of leads, the role of SOP in responsiveness to RNS remains unclear.

Design/Methods Based on diary reports or magnet swipes, we selected an average of 11 ECoGs per patient from 24 RNS-implanted patients. The SOP classification was 1b: low voltage fast activity <30Hz; 1g: low voltage fast activity (gamma); 2: high amplitude periodic spikes at 0.5-2Hz; 3: theta or alpha rhythmic sharp activity; 4: spike and wave activity at 2-4 Hz; 5: burst of high amplitude polyspikes; 6: burst suppression; and 7: delta brush at 1-2 Hz. The most common pattern was determined per patient and overall. We estimated RNS response based on >50% improvement over baseline seizure frequency prior to RNS. We then compared response rates for each predominant SOP.

Results

270 seizure-associated ECoGs were analyzed. Overall, pattern 1g was the most frequent (102; 37.78%) followed by pattern 3 (48; 17.8%). Thirteen out of 24 patients (54.2%) responded to RNS, with 1g as their predominant pattern (50%). Among non-responders, pattern 1g (45.5%) was also the most frequently seen. No clear differences were seen in responses between SOP; there were eight responders out of 13 patients with predominant pattern 1g vs. five responders out of 11 patients with other patterns (χ² = 0.62).

Conclusions Gamma activity was the predominant electrographic SOP. Based on these preliminary results, RNS efficacy appears independent of the predominant SOP.

Authors/Disclosures
Paulina Henriquez-Rojas, MD (Yale University Comprehensive Epilepsy Center) PRESENTER	No disclosure on file
Tara Torabi, MD	Dr. Torabi has nothing to disclose.
Pue Farooque, DO (NYU Langone)	No disclosure on file
Lawrence J. Hirsch, MD, FAAN (Yale University Comprehensive Epilepsy Center)	Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ceribell. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for marinus. The institution of Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Natus. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rapport Therapeutics. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker; Faculty for Fellows' training course with Neuropace. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Natus.
Robert B. Duckrow, MD (Yale University School of Medicine)	No disclosure on file
Aline Herlopian, MD (Yale University)	Dr. Herlopian has nothing to disclose.
	No disclosure on file
	No disclosure on file
Imran H. Quraishi, MD, PhD (Yale University School of Medicine)	The institution of Dr. Quraishi has received research support from NeuroPace. The institution of Dr. Quraishi has received research support from Biogen. The institution of Dr. Quraishi has received research support from Praxis Precision Medicines.

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