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Case Reports
. 2023 Jun;8(2):673-677.
doi: 10.1002/epi4.12728. Epub 2023 Mar 26.

Termination of seizures by ictal transcranial focal cortex stimulation

Martin Hirsch  1 , Volker Arnd Coenen  2   3   4 , Andreas Schulze-Bonhage  1   3
Affiliations
Case Reports

Termination of seizures by ictal transcranial focal cortex stimulation

Martin Hirsch et al. Epilepsia Open. 2023 Jun.

Abstract

Whereas high-level evidence exists on chronic neuromodulatory effects of different brain stimulation approaches in reducing seizure frequency, evidence for acute antiseizure effects of electrical brain stimulation during seizures is sparse. As part of an ongoing trial, we implanted a patient with a novel focal cortex stimulation (FCS) device with a Laplacian electrode placed over a precentral focal cortical dysplasia. The baseline seizure frequency was 125 per month, consisting of (i) focal aware sensory seizures that invariably progressed to uni- or bilateral tonic contraction and clonic jerking, and (ii) primary motor seizures. Besides an overall reduction in seizure frequency, on-demand stimulation had an immediate effect on seizures with a sensory phase, whereby 63%-86% of these seizures were terminated by ictal stimulation. These observations provide the first evidence that ictal self-triggered transcranial focal cortex stimulation can significantly interfere with the progression of seizure semiology.

Keywords: ictal stimulation; neurostimulation; seizure termination; transcranial stimulation.

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Conflict of interest statement

ASB has received research support for leading the clinical trial and recruiting patients at the Freiburg Epilepsy Center from the company PRECISIS producing the EASEE device, from the German Ministry of Research and Education, and from the Ministry of Science Baden‐Wuerttemberg for projects to develop intelligent implants for neurostimulation. MH was an investigator in the clinical trials EASEE and PIMIDES and recruited patients at the Freiburg Epilepsy Center.

Figures

FIGURE 1
FIGURE 1
Electrode positioning based on delineation of the epileptic focus by EEG and MRI. A, Scalp EEG with frequent epileptic polyspike discharges in EEG over the right central region. B, MR Imaging of a right premotor suspected bottom‐of‐sulcus dysplasia with a typical tail sign (Siemens PRISMA 3T, 3D T2‐FLAIR‐MR images in coronal, axial, and sagittal direction). C, positioning of the electrode array with electrodes in green and yellow over the bottom‐of‐sulcus dysplasia (in red) and in relation to the primary motor cortex (blue segment).
FIGURE 2
FIGURE 2
Monthly seizure counts in the case study patient preceding device implantation (M‐1), after device implantation (M0) and during active stimulation (M1‐M3). Absolute numbers are given in the bar diagram, percentages of aborted vs. continuing seizures with an initial sensory‐aware phase in the circle diagrams. Abortion of seizures during the sensory‐aware phase following patient‐triggered ictal focal cortex stimulation during M 1‐3 occurred in 63%/81%/86% of seizures in which stimulation was performed. Furthermore, there was a gradual reduction in the total seizure frequency over the 3‐month stimulation period by 23% in M3 of stimulation compared with the prospective baseline (M‐1).
See this image and copyright information in PMC

References

    1. Ben‐Menachem E, Manon‐Espaillat R, Ristanovic R, Wilder BJ, Stefan H, Mirza W, et al. Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. First international Vagus nerve stimulation study group. Epilepsia. 1994;35(3):616–26. - PubMed
    1. Fisher R, Salanova V, Witt T, Worth R, Henry T, Gross R, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia. 2010;51(5):899–908. - PubMed
    1. Salanova V, Witt T, Worth R, Henry TR, Gross RE, Nazzaro JM, et al. Long‐term efficacy and safety of thalamic stimulation for drug‐resistant partial epilepsy. Neurology. 2015;84(10):1017–25. - PMC - PubMed
    1. Nair DR, Laxer KD, Weber PB, Murro AM, Park YD, Barkley GL, et al. Nine‐year prospective efficacy and safety of brain‐responsive neurostimulation for focal epilepsy. Neurology. 2020;95(9):e1244–56. - PMC - PubMed
    1. Hampel KG, Vatter H, Elger CE, Surges R. Cardiac‐based vagus nerve stimulation reduced seizure duration in a patient with refractory epilepsy. Seizure. 2015;26:81–5. - PubMed

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