Implantation of a responsive neurostimulator device in patients with refractory epilepsy

Abstract

Object: The authors summarize one center's experience with a novel device, the Responsive Neurostimulation (RNS) system, which is used to treat seizures, and they provide technical details regarding the implantation procedure.

Methods: The authors reviewed seizure detection, cortical stimulation, and clinical data obtained in 7 patients in whom the RNS system was implanted. Data pertaining to seizure alteration are provided for the first 4 implant-treated patients. The implantation procedure in the case of one patient with occipital lobe heterotopia is included.

Results: Based on patients' seizure diaries, the implanted devices functioned at a high sensitivity for clinical seizure detection. Reductions in seizure frequency, based on their diaries and on clinic follow-up notes, ranged from 50 to 75%. No adverse stimulation-induced side effects were noted, and no hardware malfunctions requiring explantation occurred. Generator replacements for battery depletion were required at 11, 17, and 20 months in 3 patients. The implantation procedure was well tolerated, and postoperative hospital stays were short. A revision cranioplasty for a skull defect was performed in the index patient, whose case will be discussed in the most detail.

Conclusions: The results obtained in this small preliminary series demonstrate a safe implantation method for the responsive neurostimulation device.