Patient Reported Seizure Outcome Tracking in Patients with RNS for Intractable Focal Epilepsy
Abstract number :
3.303
Submission category :
9. Surgery / 9A. Adult
Year :
2023
Submission ID :
1186
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: VIBHANGINI WASADE, MD – Henry Ford Health
Gregory Barkley, MD – Henry Ford Hospital; Jason Schwalb, MD – Henry Ford Hospital; Ellen Air, MD, PhD – Henry Ford Hospital; Lonni Schultz, PhD – Henry Ford Hospital; Brien Smith, MD – Henry Ford Hospital
Rationale:
Responsive neurostimulation (RNS ® system, Neuropace Inc.) was approved by FDA for the treatment in patients with intractable focal epilepsy a decade ago. The aim of this study was to assess the seizure frequency outcomes and patients reported seizure outcomes tracking in patients with RNS treated at our NAEC level 4 program.
Methods:
RNS Patient Data Management System (PDMS) was retrospectively used to identify patients who underwent RNS implantation and who continued regular follow up at our program prior this abstract submission. Demographics and clinical data were collected that included age of epilepsy diagnosis, age of RNS implantation, location of RNS leads, and seizure outcomes analyzed by responder rates and patient reported outcome tracking. Seizure frequency reduction rates were grouped as responders ( >=50%) and super responders ( >=90%). Seizure severity response was graded as per patient reported outcome tracking (into much better, better, no change, worse and much worse categories). Chi-square tests and Wilcoxon two sample tests were done to assess the association of responder status and patient reported seizure outcomes with gender, age, or epilepsy duration at implantation, lead information and duration of implantation.
Results:
Of the patients with RNS therapy, a total of 28 patients (14 males, 14 females) were included for further analysis. At enrollment, the mean age was 36.6 years (sd=12.5) with a mean epilepsy duration at implantation of 20.3 years (sd=12.1). RNS Lead location was 17 (61%) mesial temporal, 11 (39%) neocortical (that included extra temporal), and 11 (39%) were unilateral. The mean follow up was seven years (sd=5.4, range 0.5 to 17.2 years). At last visit, 17 (61%) of the patients were responders with eight (29%) being super responders. For the eight patients with at least 13 years of follow-up, five (62.5%) were responders and one (12.5%) was a super responder. On the patient reported seizure outcome tracking, 19 (68%) had reported better seizures with nine (33%) having much better and eight (30%) had no change. The patient reported response of better outcome was significantly higher for responders than non-responders (88% vs 36%, p=0.004). Similarly, the patient reported response of much better outcome was significantly higher for super responders than patients with < 90% seizure reduction (63% vs 20%, p=0.029). It should be noted that there were patients who reported being better with less than a 50% reduction, probably because any amount reduction is better even if they are not considered a responder. Responder status and patient reported seizure outcomes were not associated with gender, age, or epilepsy duration at implantation, lead information, and duration of implantation.
Conclusions:
This study indicates significant reduction rates in seizure frequency with RNS in patients with intractable focal epilepsy with two thirds of patients reporting better seizure outcomes on patient reported seizure tracking, regardless of epilepsy duration and location of RNS lead implant. In addition, there was association noted between the recorded seizure reduction rates and patient reported seizure outcome tracking.
Funding: None
Surgery