Combining Responsive Neurostimulation Plus Resection or Ablation for Treatment of Epilepsy: A Multicenter Experience
Abstract number :
2.373
Submission category :
9. Surgery / 9A. Adult
Year :
2025
Submission ID :
172
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Christian Lopez Ramos, MD – Oregon Health & Science University
Ahmed Raslan, MD – Oregon Health & Science University
Vikram Rao, MD – Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco
Edward Chang, MD – University of California, San Francisco
Max Liu, MD – University of California, San Francisco
Vaishnav Krishnan, MD, PhD – Baylor College of Medicine
Sameer Sheth, MD, PhD – Baylor College of Medicine
Danika Paulo, MD – Baylor College of Medicine
Sanjay Patra, MD – Corewell Health
David Burdette, MD – Corewell Health
Philip McCarthy, DO – Corewell Health
Christopher Skidmore, MD – Thomas Jefferson University
Chengyuan Wu, MD – Thomas Jefferson University
Lilit Mnatsakanyan, MD – UC Irvine Medical Center
Sumeet Vadera, MD – University of California, Irvine
Dawn Eliashiv, MD – David Geffen School of Medicine at UCLA
Itzhak Fried, MD, PhD – University of California, Los Angeles
Muayad Alzuabi, MD – University of California, Los Angeles
Imran Quraishi, MD, PhD – Yale School of Medicine
Jason Gerrard, MD, PhD – University of Tennessee Health Sciences Center
Tuan Bui, BS – Yale University
Utku Uysal, MD – The University of Kansas Medical Center
Michael Kinsman, MD – Kansas University School Of Medicine
Martin McCandless, MD – Kansas University School Of Medicine
Presenting Author: Lia Ernst, MD – Oregon Health & Science University
Rationale: Drug-resistant epilepsy affects up to 40% of patients. Among surgical candidates, only one-third are eligible for resection or ablation, necessitating alternative or adjunctive strategies. Combining resection or ablation with responsive neurostimulation (RNS) has emerged as a promising approach, particularly for patients with multifocal seizure onset or eloquent cortex involvement. However, the clinical impact of combination surgery remains poorly characterized. We present the largest to date multicenter series evaluating outcomes in patients treated by combining RNS with resective or ablative surgery.
Methods: This collaborative retrospective study included 67 patients from eight epilepsy centers who underwent RNS implantation in combination with resection or laser interstitial thermal therapy (LITT), or with both surgeries preplanned and performed within 90 days of each other. All patients had at least 1 year of follow-up. Demographic, clinical, surgical, and seizure outcome data were collected and reported in a de-identified format in a secure database, in accordance with the PROCESS guidelines. Institutional Review Board approval was obtained at each site with one site (OHSU) acting as primary center who oversaw multisite coordination and processed all deidentified data.
Results: The cohort mean age was 35 years (48% female) with an average epilepsy duration of 21 years. The most common etiology was cryptogenic (24%), followed by cortical malformation (10%). Most patients experienced focal impaired awareness (FIA) (78%) and focal to bilateral tonic-clonic (FBTC) (73%) seizures. A quarter of patients had previously undergone resection. Combination procedures were performed on the same day in 88% of cases, with the remainder performed on different days. RNS was paired with resection and LITT in 91% and 9% of cases, respectively. Neocortical and mesial temporal regions accounted for 61% of resection/ablation targets. Two-thirds of RNS leads were subdural strips, with placement most often in the left hemisphere (73%). Indications for combined approach included involvement of eloquent cortex (66%) and multifocal seizure onset (33%). At one-year, the mean seizure reductions were 50.9% for focal motor seizures, 70.6% for focal impaired awareness, and 61% for FBTC seizures. 49% of patients had at least a 6-month period of seizure freedom during follow-up, and 4 patients never had seizures after surgery. Significant global clinical improvement (much or very much improved) was observed in 79% of patients. Two patients experienced device-related infections, and one patient died from SUDEP unrelated to surgical treatment.
Conclusions: Combined RNS and resection or ablation provides meaningful seizure control in cases with complex drug-resistant epilepsy with similar safety profiles to single epilepsy surgeries. These findings support the integration of hybrid surgical strategies in the management of patients with challenging seizure networks.
Funding: N/A
Surgery