Responsive neurostimulation: a new treatment option for refractory epilepsy_Journal of Epilepsy

Authors：

GUO Yafeng ¹ , LI Xi ¹ ,  ZHANG Yanke ²

1. Jining Medical University, Jining 272000, China;
2. Department of Neurology, Affiliated Hospital of Jining Medical University, Jining 272000, China;

Corresponding author：

ZHANG Yanke, Email: yankezhang@mail.jnmc.edu.cn

Keywords：

responsive neurostimulation; Closed loop system; Drug refractory epilepsy; Palliative care

DOI：

10.7507/2096-0247.202307012

Video：

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Surgical removal or destruction of the focal brain area is the main treatment for drug-resistant epilepsy, but it is not suitable for all patients. Epileptiologists in the United States have opted for a new type of palliative therapy called responsive neurostimulation (RNS). The RNS system continuously monitors the electrical activity of the brain in the area of possible seizures and places electrodes in the epileptic area to provide electrical stimulation when abnormal discharges are detected, stopping seizures. Controlled clinical trials have demonstrated the long-term effectiveness and safety of the RNS system, with continued improvement in seizure reduction rates over time. RNS system not only has a good effect on temporal lobe epilepsy and cortical functional area epilepsy, but also can dynamically monitor cortical EEG, so as to better understand the epilepsy status of each patient and provide personalized diagnosis and treatment. In this paper, the development history, structure, advantages and disadvantages of RNS system are reviewed, and its indications as palliative treatment for drug-resistant epilepsy are discussed.

Citation： GUO Yafeng, LI Xi, ZHANG Yanke. Responsive neurostimulation: a new treatment option for refractory epilepsy. Journal of Epilepsy, 2023, 9(6): 509-512. doi: 10.7507/2096-0247.202307012 Copy

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2.	Katyayan A, Diaz-Medina G. Epilepsy: epileptic syndromes and treatment. Neurol Clin, 2021, 39 (3): 779-795.
3.	Kanner AM, Bicchi MM. Antiseizure medications for adults with epilepsy: a review. JAMA, 2022, 327 (13): 1269-1281.
4.	Gonzalez HFJ, Yengo-Kahn A, Englot DJ. Vagus nerve stimulation for the treatment of epilepsy. Neurosurg Clin N Am, 2019, 30 (2): 219-230.
5.	Worrell GA. Electrical brain stimulation for epilepsy and emerging applications. J Clin Neurophysiol, 2021, 38 (6): 471-477.
6.	Vassileva A, van Blooijs D, Leijten F, et al. Neocortical electrical stimulation for epilepsy: closed-loop versus open-loop. Epilepsy Res, 2018, 141: 95-101.
7.	Yap JYY, Keatch C, Lambert E, et al. Critical review of transcutaneous vagus nerve stimulation: challenges for translation to clinical practice. Front Neurosci, 2020, 14: 284.
8.	Alarcon G, Nawoor L, Valentin A. Electrical cortical stimulation: mapping for function and seizures. Neurosurg Clin N Am, 2020, 31 (3): 435-448.
9.	Ohemeng KK, Parham K. Vagal Nerve Stimulation: indications, implantation, and outcomes. Otolaryngol Clin North Am, 2020, 53 (1): 127-143.
10.	Ghasemi P, Sahraee T, Mohammadi A. Closed- and open-loop deep brain stimulation: methods, challenges, current and future aspects. J Biomed Phys Eng, 2018, 8 (2): 209-216.
11.	Chang CW, Lee ST, Lim SN, et al. Electrical cortical stimulation for refractory focal epilepsy: a long-term follow-up study. Epilepsy Res, 2019, 151: 24-30.
12.	Jarosiewicz B, Morrell M. The RNS system: brain-responsive neurostimulation for the treatment of epilepsy. Expert Rev Med Devices, 2021, 18 (2): 129-138.
13.	Skarpaas TL, Jarosiewicz B, Morrell MJ. Brain-responsive neurostimulation for epilepsy (RNS ( (R)) System). Epilepsy Res, 2019, 153: 68-70.
14.	Sun FT, Morrell MJ. The RNS System: responsive cortical stimulation for the treatment of refractory partial epilepsy. Expert Rev Med Devices, 2014, 11 (6): 563-572.
15.	Bigelow MD, Kouzani AZ. Neural stimulation systems for the control of refractory epilepsy: a review. J Neuroeng Rehabil, 2019, 16 (1): 126.
16.	Zhang H, Chen Y, Xie Y, et al. Closed-loop controller based on reference signal tracking for absence seizures. Sci Rep, 2022, 12 (1): 6730.
17.	Musselman ED, Pelot NA, Grill WM. Empirically based guidelines for selecting vagus nerve stimulation parameters in epilepsy and heart failure. Cold Spring Harb Perspect Med, 2019, 9 (7).
18.	Koeppen JA, Nahravani F, Kramer M, et al. Electrical stimulation of the anterior thalamus for epilepsy: clinical outcome and analysis of efficient target. Neuromodulation, 2019, 22 (4): 465-471.
19.	Hescham S, Temel Y. Electrical stimulation of the fornix for the treatment of brain diseases. Handb Clin Neurol, 2021, 180: 447-454.
20.	de Oliveira T, Cukiert A. Deep brain stimulation for treatment of refractory epilepsy. Neurol India, 2021, 69 (1): 42-44.
21.	Kwon CS, Jette N, Ghatan S. Perspectives on the current developments with neuromodulation for the treatment of epilepsy. Expert Rev Neurother, 2020, 20 (2): 189-194.
22.	Davis P, Gaitanis J. Neuromodulation for the treatment of epilepsy: a review of current approaches and future directions. Clin Ther, 2020, 42 (7): 1140-1154.
23.	Lundstrom BN, Lin C, Starnes DK, et al. Safety and management of implanted epilepsy devices for imaging and surgery. Mayo Clin Proc, 2022, 97 (11): 2123-2138.
24.	Takahashi Y, Enatsu R, Kanno A, et al. Comparison of thresholds between bipolar and monopolar electrical cortical stimulation. Neurol Med Chir (Tokyo), 2022, 62 (6): 294-299.
25.	Gil-Lopez F, Boget T, Manzanares I, et al. External trigeminal nerve stimulation for drug resistant epilepsy: a randomized controlled trial. Brain Stimul, 2020, 13 (5): 1245-1253.
26.	Ryvlin P, Rheims S, Hirsch LJ, et al. Neuromodulation in epilepsy: state-of-the-art approved therapies. Lancet Neurol, 2021, 20 (12): 1038-1047.
27.	Richardson RM. Closed-loop brain stimulation and paradigm shifts in epilepsy surgery. Neurol Clin, 2022, 40 (2): 355-373.
28.	Muthiah N, Akwayena E, Vodovotz L, et al. Comparison of traditional and closed loop vagus nerve stimulation for treatment of pediatric drug-resistant epilepsy: a propensity-matched retrospective cohort study. Seizure, 2022, 94: 74-81.
29.	Haeusermann T, Lechner CR, Fong KC, et al. Closed-loop neuromodulation and self-perception in clinical treatment of refractory epilepsy. AJOB Neurosci, 2023, 14 (1): 32-44.
30.	Winston GM, Guadix S, Lavieri MT, et al. Closed-loop vagal nerve stimulation for intractable epilepsy: a single-center experience. Seizure, 2021, 88: 95-101.
31.	Dumpelmann M. Early seizure detection for closed loop direct neurostimulation devices in epilepsy. J Neural Eng, 2019, 16 (4): 041001.
32.	Opie NL, O'Brien TJ. The potential of closed-loop endovascular neurostimulation as a viable therapeutic approach for drug-resistant epilepsy: a critical review. Artif Organs, 2022, 46 (3): 337-348.
33.	Tzadok M, Harush A, Nissenkorn A, et al. Clinical outcomes of closed-loop vagal nerve stimulation in patients with refractory epilepsy. Seizure, 2019, 71: 140-144.
34.	Ge Y, Cao Y, Yi G, et al. Robust closed-loop control of spike-and-wave discharges in a thalamocortical computational model of absence epilepsy. Sci Rep, 2019, 9 (1): 9093.
35.	Schulze-Bonhage A. Long-term outcome in neurostimulation of epilepsy. Epilepsy Behav, 2019, 91: 25-29.
36.	Matias CM, Sharan A, Wu C. Responsive neurostimulation for the treatment of epilepsy. Neurosurg Clin N Am, 2019, 30 (2): 231-242.
37.	Inaji M, Yamamoto T, Kawai K, et al. Responsive neurostimulation as a novel palliative option in epilepsy surgery. Neurol Med Chir (Tokyo), 2021, 61 (1): 1-11.
38.	Xue T, Chen S, Bai Y, et al. Neuromodulation in drug-resistant epilepsy: a review of current knowledge. Acta Neurol Scand, 2022, 146 (6): 786-797.
39.	Li MCH, Cook MJ. Deep brain stimulation for drug-resistant epilepsy. Epilepsia, 2018, 59 (2): 273-290.

1. Beghi E. The epidemiology of epilepsy. Neuroepidemiology, 2020, 54 (2): 185-191.
2. Katyayan A, Diaz-Medina G. Epilepsy: epileptic syndromes and treatment. Neurol Clin, 2021, 39 (3): 779-795.
3. Kanner AM, Bicchi MM. Antiseizure medications for adults with epilepsy: a review. JAMA, 2022, 327 (13): 1269-1281.
4. Gonzalez HFJ, Yengo-Kahn A, Englot DJ. Vagus nerve stimulation for the treatment of epilepsy. Neurosurg Clin N Am, 2019, 30 (2): 219-230.
5. Worrell GA. Electrical brain stimulation for epilepsy and emerging applications. J Clin Neurophysiol, 2021, 38 (6): 471-477.
6. Vassileva A, van Blooijs D, Leijten F, et al. Neocortical electrical stimulation for epilepsy: closed-loop versus open-loop. Epilepsy Res, 2018, 141: 95-101.
7. Yap JYY, Keatch C, Lambert E, et al. Critical review of transcutaneous vagus nerve stimulation: challenges for translation to clinical practice. Front Neurosci, 2020, 14: 284.
8. Alarcon G, Nawoor L, Valentin A. Electrical cortical stimulation: mapping for function and seizures. Neurosurg Clin N Am, 2020, 31 (3): 435-448.
9. Ohemeng KK, Parham K. Vagal Nerve Stimulation: indications, implantation, and outcomes. Otolaryngol Clin North Am, 2020, 53 (1): 127-143.
10. Ghasemi P, Sahraee T, Mohammadi A. Closed- and open-loop deep brain stimulation: methods, challenges, current and future aspects. J Biomed Phys Eng, 2018, 8 (2): 209-216.
11. Chang CW, Lee ST, Lim SN, et al. Electrical cortical stimulation for refractory focal epilepsy: a long-term follow-up study. Epilepsy Res, 2019, 151: 24-30.
12. Jarosiewicz B, Morrell M. The RNS system: brain-responsive neurostimulation for the treatment of epilepsy. Expert Rev Med Devices, 2021, 18 (2): 129-138.
13. Skarpaas TL, Jarosiewicz B, Morrell MJ. Brain-responsive neurostimulation for epilepsy (RNS ( (R)) System). Epilepsy Res, 2019, 153: 68-70.
14. Sun FT, Morrell MJ. The RNS System: responsive cortical stimulation for the treatment of refractory partial epilepsy. Expert Rev Med Devices, 2014, 11 (6): 563-572.
15. Bigelow MD, Kouzani AZ. Neural stimulation systems for the control of refractory epilepsy: a review. J Neuroeng Rehabil, 2019, 16 (1): 126.
16. Zhang H, Chen Y, Xie Y, et al. Closed-loop controller based on reference signal tracking for absence seizures. Sci Rep, 2022, 12 (1): 6730.
17. Musselman ED, Pelot NA, Grill WM. Empirically based guidelines for selecting vagus nerve stimulation parameters in epilepsy and heart failure. Cold Spring Harb Perspect Med, 2019, 9 (7).
18. Koeppen JA, Nahravani F, Kramer M, et al. Electrical stimulation of the anterior thalamus for epilepsy: clinical outcome and analysis of efficient target. Neuromodulation, 2019, 22 (4): 465-471.
19. Hescham S, Temel Y. Electrical stimulation of the fornix for the treatment of brain diseases. Handb Clin Neurol, 2021, 180: 447-454.
20. de Oliveira T, Cukiert A. Deep brain stimulation for treatment of refractory epilepsy. Neurol India, 2021, 69 (1): 42-44.
21. Kwon CS, Jette N, Ghatan S. Perspectives on the current developments with neuromodulation for the treatment of epilepsy. Expert Rev Neurother, 2020, 20 (2): 189-194.
22. Davis P, Gaitanis J. Neuromodulation for the treatment of epilepsy: a review of current approaches and future directions. Clin Ther, 2020, 42 (7): 1140-1154.
23. Lundstrom BN, Lin C, Starnes DK, et al. Safety and management of implanted epilepsy devices for imaging and surgery. Mayo Clin Proc, 2022, 97 (11): 2123-2138.
24. Takahashi Y, Enatsu R, Kanno A, et al. Comparison of thresholds between bipolar and monopolar electrical cortical stimulation. Neurol Med Chir (Tokyo), 2022, 62 (6): 294-299.
25. Gil-Lopez F, Boget T, Manzanares I, et al. External trigeminal nerve stimulation for drug resistant epilepsy: a randomized controlled trial. Brain Stimul, 2020, 13 (5): 1245-1253.
26. Ryvlin P, Rheims S, Hirsch LJ, et al. Neuromodulation in epilepsy: state-of-the-art approved therapies. Lancet Neurol, 2021, 20 (12): 1038-1047.
27. Richardson RM. Closed-loop brain stimulation and paradigm shifts in epilepsy surgery. Neurol Clin, 2022, 40 (2): 355-373.
28. Muthiah N, Akwayena E, Vodovotz L, et al. Comparison of traditional and closed loop vagus nerve stimulation for treatment of pediatric drug-resistant epilepsy: a propensity-matched retrospective cohort study. Seizure, 2022, 94: 74-81.
29. Haeusermann T, Lechner CR, Fong KC, et al. Closed-loop neuromodulation and self-perception in clinical treatment of refractory epilepsy. AJOB Neurosci, 2023, 14 (1): 32-44.
30. Winston GM, Guadix S, Lavieri MT, et al. Closed-loop vagal nerve stimulation for intractable epilepsy: a single-center experience. Seizure, 2021, 88: 95-101.
31. Dumpelmann M. Early seizure detection for closed loop direct neurostimulation devices in epilepsy. J Neural Eng, 2019, 16 (4): 041001.
32. Opie NL, O'Brien TJ. The potential of closed-loop endovascular neurostimulation as a viable therapeutic approach for drug-resistant epilepsy: a critical review. Artif Organs, 2022, 46 (3): 337-348.
33. Tzadok M, Harush A, Nissenkorn A, et al. Clinical outcomes of closed-loop vagal nerve stimulation in patients with refractory epilepsy. Seizure, 2019, 71: 140-144.
34. Ge Y, Cao Y, Yi G, et al. Robust closed-loop control of spike-and-wave discharges in a thalamocortical computational model of absence epilepsy. Sci Rep, 2019, 9 (1): 9093.
35. Schulze-Bonhage A. Long-term outcome in neurostimulation of epilepsy. Epilepsy Behav, 2019, 91: 25-29.
36. Matias CM, Sharan A, Wu C. Responsive neurostimulation for the treatment of epilepsy. Neurosurg Clin N Am, 2019, 30 (2): 231-242.
37. Inaji M, Yamamoto T, Kawai K, et al. Responsive neurostimulation as a novel palliative option in epilepsy surgery. Neurol Med Chir (Tokyo), 2021, 61 (1): 1-11.
38. Xue T, Chen S, Bai Y, et al. Neuromodulation in drug-resistant epilepsy: a review of current knowledge. Acta Neurol Scand, 2022, 146 (6): 786-797.
39. Li MCH, Cook MJ. Deep brain stimulation for drug-resistant epilepsy. Epilepsia, 2018, 59 (2): 273-290.

Journal of Epilepsy

Responsive neurostimulation: a new treatment option for refractory epilepsy

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