Non-Invasive Limb Proprioceptive Cerebellar Stimulation in Drug-Resistant Epilepsy
Abstract number :
3.092
Submission category :
2. Translational Research / 2B. Devices, Technologies, Stem Cells
Year :
2021
Submission ID :
1826410
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:54 AM
Authors :
Ronald Harper, PhD - UCLA; Dieter Hertling – Neurology – Olive View-UCLA Medical Center; Ashley Curtis – Neurology – Olive View-UCLA Medical Center; Eberhardt Sauerland – Physiology – University of Nevada, Reno; Christopher De Giorgio – Neurology – Olive View-UCLA Medical Center
Rationale: Electrical stimulation to cerebellar sites reduces the frequency of seizures in animals and in humans with drug-resistant epilepsy. To activate comparable processes non-invasively, we applied continuous cutaneous vibratory stimulation to foot limb proprioceptive receptors that project to cerebellar, pontine, and thalamic sites in drug-resistant epilepsy patients.
Methods: After institutional review board approval and written informed consent by the patient or guardian, five subjects, 4 male and 1 female, aged 21-36 years with drug-resistant epilepsy (failed > 3 medications) were recruited for a pilot open-label feasibility study. Subjects were at high risk for sudden unexpected death (SUDEP) (mean SUDEP-7R score of 6.8/9, normal = 0). Patients were subjected to mechanical vibratory stimulation to the sole of one foot for 8-hrs at night up to 6-months following a 4-week no-stimulation baseline. No changes in antiseizure medications were allowed during the study. Seizure frequency was evaluated during the 4-week baseline control period, and at six, twelve, and twenty-four weeks.
Results: Five subjects completed at least the first 6-week treatment (three Lennox-Gastaut, one cortical dysplasia, one unknown etiology). At 12 weeks, the median reduction in seizure frequency was -28.0%; two subjects continued for 24 weeks, with a reduction in seizure frequency of -44.1 and -45.4%. The intervention was well tolerated, and no tissue injury appeared from the vibratory interface.
Conclusions: Nocturnal non-invasive vibratory stimuli to cutaneous limb areas containing proprioceptors reduced the frequency of seizures in a small group of drug-resistant patients with epilepsy at high risk for SUDEP. We speculate that the reduction in seizure frequency is mediated principally by cerebellar mechanisms, in a fashion that may parallel direct electrical stimulation of cerebellar sites. This pilot study provides support for further clinical studies into the safety and efficacy of limb proprioceptive stimulation for epilepsy.
Funding: Please list any funding that was received in support of this abstract.: This research was supported by unrestricted funds to UCLA from: The Fidelity Charitable Nancy Adams and Scott Schoen Fund; the Kraig and Linda Kupiec Family Trust; and James and Beverly Peters.
Translational Research