Pilot data on responsive epilepsy neurostimulation, measures of sleep apnea and continuous glucose measurements

Kinnear, Katie M.; Warner, Nicole M.; Gersappe, Anand; Doherty, Michael

doi:10.1016/j.ebcr.2017.12.004

Cited by 5 publications

(6 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Yet, there is scant existing literature on the relationship between brain‐responsive neurostimulation and sleep. Our findings are consistent with a prior case report that did not find obvious effects of RNS System stimulation on progression through sleep stages, but this study involved a single subject with only mesial temporal leads, did not examine arousals in relation to stimulations, and did not correlate ECoG with PSG data.…”

Section: Discussionsupporting

confidence: 91%

“…Our study design afforded a rare opportunity to correlate sleep features on PSG with concurrent intracranial recordings . To examine the relationships among stimulations, arousals, and epileptiform activity in more detail, we visually compared ECoGs recorded by the RNS System (subject 1: two 180‐seconds ECoGs; all other subjects: two 90‐seconds ECoGs) with their temporally corresponding portions of PSG.…”

Section: Resultsmentioning

confidence: 99%

“…Thalamic DBS disrupts sleep in a dose (voltage)‐dependent manner, possibly helping to explain the adverse neuropsychiatric effects (memory loss, depression) associated with this therapy . Potential effects on sleep of RNS System treatment have been described only in a limited case report …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sleep disruption is not observed with brain‐responsive neurostimulation for epilepsy

Ruoff

Jarosiewicz

et al. 2020

Epilepsia Open

View full text Add to dashboard Cite

Objective: Neurostimulation devices that deliver electrical impulses to the nervous system are widely used to treat seizures in patients with medically refractory epilepsy, but the effects of these therapies on sleep are incompletely understood. Vagus nerve stimulation can contribute to obstructive sleep apnea, and thalamic deep brain stimulation can cause sleep disruption. A device for brain-responsive neurostimulation (RNS ® System, NeuroPace, Inc) is well tolerated in clinical trials, but potential effects on sleep are unknown. Methods: Six adults with medically refractory focal epilepsy treated for at least six months with the RNS System underwent a single night of polysomnography (PSG).RNS System lead locations included mesial temporal and neocortical targets. Sleep stages and arousals were scored according to standard guidelines. Stimulations delivered by the RNS System in response to detections of epileptiform activity were identified by artifacts on scalp electroencephalography. Results: One subject was excluded for technical reasons related to unreliable identification of stimulation artifact on EEG during PSG. In the remaining five subjects, PSG showed fragmented sleep with frequent arousals. Arousal histograms aligned to stimulations revealed a significant peak in arousals just before stimulation. In one of these subjects, the arousal peak began before stimulation and extended ~1 seconds after stimulation. A peak in arousals occurring only after stimulation was not observed. Significance: In this small cohort of patients, brain-responsive neurostimulation does not appear to disrupt sleep. If confirmed in larger studies, this could represent a potential clinical advantage of brain-responsive neurostimulation over other neurostimulation modalities. K E Y W O R D S arousal, brain-responsive neurostimulation, epilepsy, polysomnography, RNS, sleep 156 | RUOFF et al. | 157 RUOFF et al.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Sleep disruption is not observed with brain‐responsive neurostimulation for epilepsy

Ruoff

Jarosiewicz

et al. 2020

Epilepsia Open

View full text Add to dashboard Cite

show abstract

“…( Fig. 2 ) [25] . A one night study is unlikely to represent this patient's sleep during the study, but may at least permit speculation about how sleep staging could drive a sleep vs. wake glucose requirement in differing brain areas.…”

Section: Discussionmentioning

confidence: 99%

Continuous monitoring devices and seizure patterns by glucose, time and lateralized seizure onset

Kinnear¹,

Warner²,

Haltiner³

et al. 2018

Epilepsy & Behavior Case Reports

Self Cite

View full text Add to dashboard Cite

ObjectivesTo investigate if glucose levels influence seizure patterns.Materials and methodsIn a patient with RNS/NeuroPace implanted bi-temporally and type 1 diabetes mellitus, seizure event times and onset locations were matched to continuous tissue glucose.ResultsLeft focal seizure (LFS, n = 22) glucoses averaged 169 mg/dL, while right focal seizure (RFS, n = 23) glucoses averaged 131 mg/dL (p = 0.03). LFS occurred at mean time 17:02 while RFS occurred at 04:23. LFS spread to the contralateral side (n = 19) more than RFS (n = 2).ConclusionSeizure onset laterality and spread vary with glucose and time of seizure.

show abstract

“…Once an abnormal activity is detected, the device supplies responsive therapeutic electrical stimulation designed to reduce or abort the seizures. [4,20,36] This may be used as a palliative approach for patients with eloquent, multiple, or broad epileptogenic foci. [23] Intracranial monitoring may be performed before RNS implantation to guide electrode placement.…”

Section: Rnsmentioning

confidence: 99%

An update on pediatric surgical epilepsy: Part II

Gadgil

Muir

LoPresti

et al. 2019

Surgical Neurology International

View full text Add to dashboard Cite

Background: Recent advances may allow surgical options for pediatric patients with refractory epilepsy not previously deemed surgical candidates. This review outlines major technological developments in the field of pediatric surgical epilepsy. Methods: The literature was comprehensively reviewed and summarized pertaining to stereotactic electroencephalography (sEEG), laser ablation, focused ultrasound (FUS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) in pediatric epilepsy patients. Results: sEEG allows improved seizure localization in patients with widespread, bilateral, or deep-seated epileptic foci. Laser ablation may be used for destruction of deep-seated epileptic foci close to eloquent structures; FUS has a similar potential application. RNS is a palliative option for patients with eloquent, multiple, or broad epileptogenic foci. DBS is another palliative approach in children unsuitable for respective surgery. Conclusion: The landscape of pediatric epilepsy is changing due to improved diagnostic and treatment options for patients with refractory seizures. These interventions may improve seizure outcomes and decrease surgical morbidity, though further research is needed to define the appropriate role for each modality.

show abstract

Pilot data on responsive epilepsy neurostimulation, measures of sleep apnea and continuous glucose measurements

Cited by 5 publications

References 5 publications

Sleep disruption is not observed with brain‐responsive neurostimulation for epilepsy

Sleep disruption is not observed with brain‐responsive neurostimulation for epilepsy

Continuous monitoring devices and seizure patterns by glucose, time and lateralized seizure onset

An update on pediatric surgical epilepsy: Part II

Contact Info

Product

Resources

About