Abstract Details

Title Dual Device Neurostimulation in Drug Resistant Epilepsy

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-007

Objective To evaluate patients who have undergone deep brain stimulation (DBS) or responsive neurostimulation (RNS) after vagus nerve stimulation (VNS).

Background In many patients with drug-resistant epilepsy (DRE), neuromodulation with VNS, DBS, and RNS reduces seizure frequency but rarely produces seizure freedom [1-4]. Despite increasing use of neuromodulation, dual neurostimulation has received limited attention [5]. Therefore, it is unclear if there are differences in efficacy and safety, or if clinical factors are present that may allow for an individualized treatment plan.

Design/Methods We reviewed the Mayo Clinic database in Florida of patients who underwent VNS, DBS, and RNS device implantation (1/1/2011-9/30/2021). Review was supplemented from industry-held databases of neurostimulator placement. The prevalence of prior VNS in those treated with DBS and/or RNS neuromodulation was recorded as dual-device neurostimulation (VNS-DBS or VNS-RNS). We compared clinical features and seizure responsiveness in VNS-DBS and VNS-RNS.

Results Of 29 patients who underwent RNS, 6 had prior VNS. All 8 patients who underwent DBS had previously undergone VNS (6 anterior thalamic; 2 centromedian thalamic). Two VNS-RNS patients had VNS explanted compared with none using VNS-DBS. VNS-DBS patients failed more antiseizure medication trials (11.9 vs. 6.2, p=0.020). VNS-RNS patients had more well localized epileptic foci (p<0.001), were more likely to have undergone invasive EEG monitoring (p<0.001), and were more likely to have had PET or SPECT imaging (p<0.001). VNS-DBS patients had more favorable prior response to VNS (p=0.025), and 4/4 patients who responded to VNS also saw improvement after DBS. One VNS-DBS patient had DBS explanted at 15 months due to secondary lead infection from meningitis; no other adverse events were documented.

Conclusions VNS-RNS resulted in more extensive testing including invasive EEG study. VNS-DBS patients were more likely to demonstrate an initial response to VNS. Prospective multi-center studies are needed to validate differences in combined neurostimulation and advance decision-making with polyneurostimulation.

Authors/Disclosures
Brin Freund, MD PRESENTER	Dr. Freund has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Freund has received research support from Mayo Clinic.
Diogo Garcia	No disclosure on file
Anteneh M. Feyissa, MD, MSc, FAAN (Mayo Clinic)	Dr. Feyissa has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurelis.
Anthony L. Ritaccio, MD, FAAN (Mayo Clinic)	The institution of Dr. Ritaccio has received research support from NIH. Dr. Ritaccio has received intellectual property interests from a discovery or technology relating to health care.
Joseph I. Sirven, MD, FAAN (Mayo Clinic)	Dr. Sirven has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Sirven has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neurelis. Dr. Sirven has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurona. Dr. Sirven has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. Dr. Sirven has received publishing royalties from a publication relating to health care. Dr. Sirven has received personal compensation in the range of $10,000-$49,999 for serving as a Host/ Co producer with WJCT Public Media. Dr. Sirven has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant with Federal Aviation Administration .
Erik Middlebrooks	Erik Middlebrooks has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Boston Scientific Corp. Erik Middlebrooks has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Siemens Healthineers. Erik Middlebrooks has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Journal of Neuroradiology.
Sanjeet S. Grewal, MD	Sanjeet S. Grewal, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic.
William O. Tatum IV, DO, FAAN (Mayo Clinic)	Dr. Tatum has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bioserenity. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Natus. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Tatum has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Defense Law Firm on behalf of a patient with epilepsy with funds donated to the Epilepsy Foundation of America. The institution of Dr. Tatum has received research support from Esai. The institution of Dr. Tatum has received research support from Mayo Clinic. The institution of Dr. Tatum has received research support from Liva Nova. The institution of Dr. Tatum has received research support from Engage Pharmaceuticals. The institution of Dr. Tatum has received research support from Xenon. Dr. Tatum has received intellectual property interests from a discovery or technology relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has received publishing royalties from a publication relating to health care. Dr. Tatum has a non-compensated relationship as a AAN Section Chair of Clinical Neurophysiology with AAN that is relevant to AAN interests or activities.

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