Abstracts

Rationale: Chronic, intractable epilepsy may have significant impacts on behavior and cognition, especially in patients with severe and frequent seizures.  For patients with intractable epilepsy, successful epilepsy surgery leading to seizure freedom or better seizure control may lead to improvements in behavior.  The Neuropace RNS system is a relatively new, surgically implanted brain stimulation device for chronic intractable epilepsy.  The majority of patients utilizing the Neuropace RNS system have a significant reduction in their seizure frequency or severity with some achieving complete seizure freedom.  We present two patients with chronic, intractable epilepsy who have experienced improvements in behavior following implantation and use of the Neuropace RNS system. Methods: Ten patients had a total of eleven Neuropace RNS systems surgically implanted over a four year period at Inova Fairfax Hospital.  The parents of two of the patients with implanted Neuropace RNS systems reported significant improvements in problematic behaviors following the implantation and activation of the Neuropace RNS system.  These two case studies are presented here.  Results: The first patient is a 26 year old woman who has had seizures since an episode of encephalitis as a teenager.  She had a vagal nerve stimulator placed that did not eliminate her seizures.  She was experiencing several complex partial and secondarily generalized seizures per month.  She had MRI findings consistent with hippocampal sclerosis in the left temporal lobe and electrocorticography demonstrating right hippocampal seizure onset.  She was not a candidate for temporal lobectomy and hippocampectomy.  She underwent surgical placement of the Neuropace RNS system with electrodes in bilateral hippocampi.  She experienced a significant reduction in her seizure frequency following surgery.  Prior to surgery, she experienced significant psychiatric and behavioral problems including two psychiatric hospital admissions in the year prior to Neuropace RNS placement.  In the nearly three years since the placement of the Neuropace RNS, her parents report significant reduction in her seizures and improvement in her psychiatric condition with only one psychiatric hospitalization in that period of time.  The second patient is a 28 year old man with a history of Asperger’s syndrome and chronic, intractable generalized epilepsy.  He experienced a prolonged episode of status epilepticus requiring surgical resection of a seizure focus and a right temporal lobectomy with hippocampectomy to control the status epilepticus.  His seizures continued from the left hippocampus and left temporal lobe neocortex.  He had surgical implantation of a Neuropace RNS system with a depth electrode in the left hippocampus and a subdural electrode over the left temporal lobe.  Three months after placement of the Neuropace RNS system, the patient’s mother reported shorter and less severe seizures as well as improvements in behavior including the patient expressing himself, talking more, and having increased social and emotional awareness.  Conclusions: A potential secondary effect of better seizure control using the surgically implanted Neuropace RNS system is an improvement in behavior problems. Funding: No funding