Authors :
Presenting Author: Katrina Munoz, MBE – Emory University School of Medicine
Dale Tager, MD, MBA – Weill Cornell School of Medicine
Jimmy Yang, MD – Ohio State University
Katie Bullinger, MD, PhD – Emory University School of Medicine
Abdulrahman Alwaki, MD – University of Pittsburgh Medical Center
David Loring, PhD – Emory University School of Medicine
Ekaterina Staikova, PhD – Emory University School of Medicine
Cady Block, PhD – Emory University School of Medicine
Jon Willie, MD, PhD – Washington University School of Medicine
Robert Gross, MD, PhD – Rutgers New Jersey Medical School
Daniel Drane, PhD – Emory University
Ioannis Karakis, MD, PhD, MS – University of Crete School of Medicine
Rationale:
The impact of deep brain stimulation (DBS) on neuropsychiatric and psychosocial outcomes in patients with drug-resistant epilepsy (DRE) has not been thoroughly examined beyond original clinical trials and post-approval studies. This study aimed to investigate real-world effects of DBS on cognitive, psychiatric, and quality of life (QOL) outcomes with respect to seizure outcomes.
Methods:
A retrospective review was performed on forty-four patients who underwent DBS implantation for DRE at our institution between 2018 and 2023. Patient demographics and baseline seizure characteristics were collected, along with cognitive (Full-Scale Intelligence Quotient, Verbal Comprehension and Perceptual Reasoning Index), psychiatric (Beck Depression and Anxiety Inventory Scores), and QOL (QOLIE-31) outcomes at 6- and 12-months post DBS implantation and were further correlated with seizure outcomes.
Results:
Forty-four patients (median age 36 years, 52% female) received bilateral electrode implantation of the thalamus (82% anterior nucleus, 18% centromedian nucleus) for DRE. Of the 41 patients with available pre- and post-implantation seizure counts, the 6-month and one-year median seizure frequency reduction were 63% and 65% respectively, the response rate (50% or greater seizure frequency reduction) was 70% at one year, and 7% of patients were free of disabling seizures regardless of thalamic target. Of the 21 patients with pre- and post-implantation neuropsychological data, no significant difference was identified at a group level in cognitive, psychiatric, and QOL outcomes at one year post-implantation compared to baseline, regardless of thalamic target and seizure outcomes.
Conclusions:
Despite limitations of a small sample size, this single center study offers real world data that DBS is effective for reducing seizure frequency in DRE. Moreover, DBS for DRE does not have a statistically significant negative or positive impact on the neuropsychiatric and psychosocial outcomes. Individual variability in clinical characteristics will require careful patient selection and outcome monitoring.
Funding:
This study was funded in part by R01 NS088748 awarded by the NIH/NINDS to Dr. Daniel Drane.