Responsive Neural Stimulation (RNS) in a case of reflex epilepsy
Abstract number :
361
Submission category :
8. Non-AED/Non-Surgical Treatments (Hormonal, alternative, etc.)
Year :
2020
Submission ID :
2422706
Source :
www.aesnet.org
Presentation date :
12/6/2020 12:00:00 PM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Elakkat D.Gireesh, AdventHealth; Holly Skinner - AdventHealth Orlando; Kihyeong Lee - AdventHealth Orlando; Janes Baumgartner - AdventHealth Orlando; Michael Westerveld - AdventHealth Orlando;;
Rationale:
Reflex epilepsies involve seizures which are usually triggered by either internal or external stimulus. While the semiology in these cases provide important clues about the epileptogenic zones, generally these zones are close to or at eloquent cortex. We report a case of intractable reflex sensory motor epilepsy that was treated with RNS, with complete seizure freedom for the last 18 months.
Method:
The patient started having seizures since the age of 7 years. The semiology included tingling in his left hand/fingers, followed by posturing of his hand/ wrist, and then jerking of the left upper extremity. His head and upper body also turned to the right during some of seizures. The seizures can proceed to involve his left leg. The seizures could be triggered by shaking of the left hand indicating the reflex nature of the seizures.
Given the intractable nature of the seizures, epilepsy surgery was planned at the age of 15 years. Interictal EEG showed spikes in the right central regions (C4). He underwent epilepsy surgery with intracranial monitoring employing right fronto-parietal subdural grid coverage. He underwent right parietal topectomy and right frontal multiple subpial transection, in order to spare the motor cortex. The seizures continued and a repeat intracranial monitoring was done at the age of 17 years, followed by resection of the right parietal cortex, excluding the sensory motor cortex.
Results:
Since the patient continued to have seizures, as frequent as 5-10/day, repeat intracranial monitoring with stereo EEG was done at the age of 21 years and epileptogenic zone was noted at the right sensorimotor regions. Patient was implanted with RNS and seizure freedom was achieved within 1 month of implantation and he has remained seizure free for the last 18 months. He reported having aura on lowering antiepileptic medications and therefore continues to be on antiepileptic mediations.
Conclusion:
Our experience suggest that the RNS can be used as an effective treatment option for intractable reflex epilepsy.
Funding:
:No funding source
Non-AED/Non-Surgical Treatments