Document Detail


Closed-loop stimulation in the control of focal epilepsy of insular origin.
MedLine Citation:
PMID:  20588079     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Previous studies have shown that closed-loop or responsive neurostimulation can abort induced or spontaneous epileptiform discharges.
OBJECTIVE: To assess the effectiveness of a programmable cranially implanted closed-loop neurostimulation system in the control of seizures originating from an area relatively inaccessible by open craniotomy.
METHOD: A patient with drug-resistant partial epilepsy had previously undergone open resection of the left frontal opercular cortex and the underlying insular area. Although subdural-depth electrode ictal recordings had been nonlocalizing, depth electrode insular stimulation had produced the patient's habitual aura. Postoperatively, there was a sustained 50% reduction in seizure frequency. The residual seizures were identical to the preoperative seizures. Repeat depth electrode monitoring revealed that the ictal focus was immediately posterior to the previously resected insular area. A closed-loop cranial internal pulse generator system including left anterior insular and posterior orbitofrontal depth electrodes was implanted.
RESULT: There was an additional 60% reduction of seizures.
CONCLUSION: Preliminary observation indicates that responsive neurostimulation may be an effective alternative to higher-risk resective epilepsy surgery.
Authors:
Joseph R Smith; Kostas N Fountas; Anthony M Murro; Yong D Park; Patrick D Jenkins; Martha Morrell; Rosanna Esteller; David Greene
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-06-24
Journal Detail:
Title:  Stereotactic and functional neurosurgery     Volume:  88     ISSN:  1423-0372     ISO Abbreviation:  Stereotact Funct Neurosurg     Publication Date:  2010  
Date Detail:
Created Date:  2010-09-14     Completed Date:  2010-12-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8902881     Medline TA:  Stereotact Funct Neurosurg     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  281-7     Citation Subset:  IM    
Copyright Information:
2010 S. Karger AG, Basel.
Affiliation:
Department of Neurosurgery, Medical College of Georgia, Augusta, GA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cerebral Cortex / surgery*
Electric Stimulation Therapy*
Electroencephalography
Epilepsies, Partial / therapy*
Humans
Implantable Neurostimulators
Male
Neurologic Examination
Neuropsychological Tests
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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