Epilepsy, An Issue of Neurosurgery Clinics

Nicholas Barbaro, Edward F. Chang

Description

In this issue of Neurosurgery Clinics, Drs. Chang and Barbaro provide a thorough look at epilepsy, with sections focusing on devices in epilepsy surgery, open loop systems, closed loop systems, and non-stimulation. Topics in this issue include history and overview of stimulation for epilepsy, trigeminal nerve stimulation, anterior thalamus DBS, hippocampal stimulation, neuropace RNS, seizure detection/prediction algorithms, cooling, seizure prediction and its applications, stimulation paradigms, and experimental stimulation.

Sujets

• Medical
• Médecine
• Surgery
• Neurosurgery

Informations

• Publié par: Saunders
• Date de parution: 28 octobre 2011
• Nombre de lectures: 0
• EAN13: 9781455712144
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Neurosurgery Clinics of North America , Vol. 22, No. 4, October 2011
ISSN: 1042-3680
doi: 10.1016/S1042-3680(11)00089-1

Contributors
Neurosurgery Clinics of North America
Epilepsy Surgery: The Emerging Field of Neuromodulation
GUEST EDITORS: Edward F. Chang, MD
Departments of Neurological Surgery and Physiology, University of California, San Francisco, 505 Parnassus Avenue, Room M779, San Francisco, CA 94143-0112, USA
Nicholas M. Barbaro, MD
Departments of Neurological Surgery and Physiology, University of California, San Francisco, 505 Parnassus Avenue, Room M779, San Francisco, CA 94143-0112, USA
CONSULTING EDITORS: Andrew T. Parsa, MD, PhD
Paul C. McCormick, MD, PhD
ISSN  1042-3680
Volume 22 • Number 4 • October 2011

Contents
Cover
Contributors
Forthcoming Issues
Epilepsy Surgery: The Emerging Field of Neuromodulation
Electrical Stimulation for Epilepsy: Experimental Approaches
Efficacy of Vagus Nerve Stimulation for Epilepsy by Patient Age, Epilepsy Duration, and Seizure Type
Trigeminal Nerve Stimulation: Seminal Animal and Human Studies for Epilepsy and Depression
Thalamic Stimulation for Epilepsy
Hippocampal Stimulation in the Treatment of Epilepsy
Responsive Neurostimulation for the Treatment of Epilepsy
Responsive Neurostimulation Suppresses Synchronized Cortical Rhythms in Patients with Epilepsy
Seizure Prediction and its Applications
Features and Futures: Seizure Detection in Partial Epilepsies
Implanted Subdural Electrodes: Safety Issues and Complication Avoidance
Focal Cooling Devices for the Surgical Treatment of Epilepsy
Index
Neurosurgery Clinics of North America , Vol. 22, No. 4, October 2011
ISSN: 1042-3680
doi: 10.1016/S1042-3680(11)00091-X

Forthcoming Issues
Neurosurgery Clinics of North America , Vol. 22, No. 4, October 2011
ISSN: 1042-3680
doi: 10.1016/j.nec.2011.07.012

Preface
Epilepsy Surgery: The Emerging Field of Neuromodulation

Edward F. Chang, MD , Nicholas M. Barbaro, MD ,
Departments of Neurological Surgery and Physiology, University of California, San Francisco, 505 Parnassus Avenue, Room M779, San Francisco, CA 94143-0112, USA
E-mail address: [e-mail]
E-mail address: [e-mail]


Edward F. Chang, MD, Guest Editor

Nicholas M. Barbaro, MD, Guest Editor
Epilepsy is a devastating neurological disorder that afflicts nearly 1% of the population. While resective surgery has been demonstrated to have excellent seizure-control outcomes in selected patients, many others are not candidates because the epileptogenic zone is multifocal and/or includes eloquent brain regions. Furthermore, resective surgery can be associated with neurocognitive effects, which are sometimes irreversible.
Over the last 30 years, tremendous progress has been made in expanding non-resective approaches to epilepsy surgery. With new advances in seizure detection, signal processing, and electrical stimulation, there is significant interest in developing a new generation of implantable devices for patients with intractable seizure disorders.
In this issue, we focus on emerging device technology in the field of epilepsy surgery. The articles are a compilation of topics that are highly relevant to neural interface technology. We are pleased to have significant contributions from experts in engineering, neurology, basic neuroscience, and neurosurgery. Together, they address the theoretical background, recent advances in research, and clinical outcomes of current and future devices in epilepsy surgery.
To start, Rolston and colleagues provide a comprehensive in-depth review of progress and obstacles in recording and stimulation technology applied to epilepsy. Several structures of the nervous system have been proposed as potential targets of device-based neuromodulation. Currently, the only FDA-approved device for epilepsy is the Vagal Nerve Stimulation by Cyberonics, Inc. Englot and coworkers report the largest analysis of VNS outcomes and their predictors performed to date from thousands of patients in the Cyberonics registry.
As a promising alternative to the extracranial-based device, DeGiorgio and colleagues report the development of infraorbital or supraorbital trigeminal nerve stimulation. This new approach offers the possibility of testing efficacy percutaneously before implantation.
The majority of other devices involve direct intracranial stimulation. Ooi and coworkers review the available literature on the anterior thalamus as a target for deep brain stimulation, including technical nuances and clinical results for this target. Tellez-Zenteno and Wiebe present a critical review of the emerging evidence for hippocampal stimulation as well as outlining what outstanding questions remain for prospective trials of efficacy.
Closed-loop systems that detect seizures to then trigger electrical stimulation to abort them are making clinical progress. Gigante and Goodman provide a historical overview and report on recent clinical trials conducted for the Responsive Neurostimulation System (RNS) from Neuropace. How cortical stimulation reduces seizures is unclear. Sohal and Sun report novel mechanistic findings from patients implanted with the RNS system, suggesting that stimulation acutely desynchronizes long-range gamma frequency activity, thereby functionally “disconnecting” the epileptogenic network.
Unpredictability is a major factor contributing to the morbidity and mortality related to seizures. Recent advances in seizure prediction research are leading to wide-ranging potential applications including systems that can warn patients of impending seizures or triggering stimulation in closed loop devices. Iasemidis presents an excellent review of how a dynamical systems approach applied to epilepsy has led to a better understanding of seizure onsets, periods of susceptibility, and localization. Han and colleagues report on the powerful application of independent components analysis for improving the reliability and robustness of seizure detection and localization.
For intracranial devices, subdural or depth electrodes are the most common interface with the brain parenchyma. Fountas performed a systematic review of the literature to report the safety and complication avoidance associated with chronic indwelling electrodes.
Finally, Smyth and Rothman describe a completely alternative approach using focal cortical cooling. They present an overview of the rationale and preclinical data in animals and humans leading to the development of implantable cooling devices.
The field of neuromodulation for epilepsy is in its infancy, and significant knowledge gaps remain regarding how best to apply rapidly developing technology to achieve the best clinical outcomes. This issue is intended to stimulate further efforts in innovative uses of technology to suppress seizures without inducing unwanted side effects.
Neurosurgery Clinics of North America , Vol. 22, No. 4, October 2011
ISSN: 1042-3680
doi: 10.1016/j.nec.2011.07.010

Electrical Stimulation for Epilepsy: Experimental Approaches

John D. Rolston, MD, PhD a , Sharanya Arcot Desai, BE, MSc b , c , Nealen G. Laxpati, BS b , d , Robert E. Gross, MD, PhD b , d , e , *
a Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, Room 779M, San Francisco, CA 94143, USA
b Department of Neurosurgery, Emory University School of Medicine, 1365-B Clifton Road Suite 2200, Atlanta, GA 30322, USA
c Laboratory for Neuroengineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA 30332, USA
d Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA 30332, USA
e Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA 30322, USA
* Corresponding author. Department of Neurosurgery, Emory University School of Medicine, 1365-B Clifton Road Suite 2200, Atlanta, GA 30322.
E-mail address: [e-mail]

Abstract
Direct electrical stimulation of the brain is an increasingly popular means of treating refractory epilepsy. Although there has been moderate success in human trials, the rate of seizure freedom does not yet compare favorably to resective surgery. It therefore remains critical to advance experimental investigations aimed toward understanding brain stimulation and its utility. This article introduces the concepts necessary for understanding these experimental studies, describing recording and stimulation technology, animal models of epilepsy, and various subcortical targets of stimulation. Bidirectional and closed-loop device technologies are also highlighted, along with the challenges presented by their experimental use.

Keywords
• Brain electrical stimulation • Epilepsy • Animal models of epilepsy • Recording and stimulation technology
Direct electrical stimulation of the brain is an increasingly popular means of treating refractory epilepsy. 1 Although there has been moderate success in human trials, the rate of seizure freedom does not yet compare favorably to resective surgery. 1 It therefore remains critical to advance experimental investigations aimed toward understanding brain stimulation and its utility. This article introduces the concepts necessary for understanding these experimental studies, describing recording and stimulation technology, animal models of epilepsy, and the various subcortical tar