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Chapter 24 - Neurostimulation for the Treatment of Insular Epilepsy

from Section 5 - Surgical Management of Insular Epilepsy

Published online by Cambridge University Press:  09 June 2022

By
Patricia C. Dugan  and
Barbara C. Jobst
Edited by
Dang Nguyen ,
Jean Isnard  and
Philippe Kahane
Dang Nguyen
Affiliation:
Université de Montréal
Jean Isnard
Affiliation:
Claude Bernard University Lyon
Philippe Kahane
Affiliation:
Grenoble-Alpes University Hospital
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Summary

The surgical treatment of refractory insular epilepsy is challenging because of its deep-seated anatomical location, the rich vasculature within this region, and its connectivity with highly eloquent brain regions. Neurostimulation is a burgeoning complementary treatment for drug-resistant epilepsy patients who may not be candidates for surgical resection. There is Class I evidence supporting the efficacy and safety of responsive neurostimulation (RNS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS) of the anterior nucleus of the thalamus. All of these modalities have comparable efficacy, as demonstrated in their respective pivotal trials and subsequent longer-term trials. There is, however, a paucity of published data at this time describing their use specifically for the treatment of refractory extratemporal epilepsy or insular epilepsy in particular.

Keywords

surgeryneurostimulationvagus nerve stimulationresponsive neurostimulationdeep brain stimulation
Type
Chapter
Information
Insular Epilepsies , pp. 278 - 286
Publisher: Cambridge University Press
Print publication year: 2022

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References

Rolston, JD, Englot, DJ, Wang, DD, et al. Comparison of seizure control outcomes and the safety of vagus nerve, thalamic deep brain, and responsive neurostimulation: Evidence from randomized controlled trials. Neurosurg Focus. 2012;32(3):E14.CrossRefGoogle ScholarPubMed
Boon, P, De Cock, E, Mertens, A, et al. Neurostimulation for drug-resistant epilepsy: A systematic review of clinical evidence for efficacy, safety, contraindications and predictors for response. Curr Opin Neurol. 2018;31(2):198–210.Google Scholar
Benbadis, SR, Geller, E, Ryvlin, P, et al. Putting it all together: Options for intractable epilepsy. An updated algorithm on the use of epilepsy surgery and neurostimulation. Epilepsy Behav. 2018;88S:33–38.CrossRefGoogle ScholarPubMed
Ikegaya, N, Takahashi, A, Kaido, T, et al. Surgical strategy to avoid ischemic complications of the pyramidal tract in resective epilepsy surgery of the insula: Technical case report. J Neurosurg. 2018;128(4):1173–1177.Google Scholar
Barba, C, Rheims, S, Minotti, L, et al. Temporal plus epilepsy is a major determinant of temporal lobe surgery failures. Brain. 2016;139(pt 2):444–451.Google Scholar
Bourdillon, P, Ryvlin, P, Isnard, J, et al. Stereotactic electroencephalography is a safe procedure, including for insular implantations. World Neurosurg. 2017;99:353–361.CrossRefGoogle ScholarPubMed
Bouthillier, A, Nguyen, DK. Epilepsy surgeries requiring an operculoinsular cortectomy: Operative techniques and results. Neurosurgery. 2017;81(4):602–612.Google Scholar
Von Lehe, M, Wellmer, J, Urbach, H, et al. Insular lesionectomy for refractory epilepsy: Management and outcome. Brain. 2009;132(pt 4):1048–1056.Google Scholar
Von Lehe, M, Parpaley, Y. Insular cortex surgery for the treatment of refractory epilepsy. J Clin Neurophysiol. 2017 Jul;34(4):333–339.CrossRefGoogle ScholarPubMed
Bouthillier, A, Weil, AG, Martineau, L, et al. Operculoinsular cortectomy for refractory epilepsy. Part 1: Is it safe? J Neurosurg. 2019 Sep;20:1–11.Google Scholar
Klein, TA, Ullsperger, M, Danielmeier, C. Error awareness and the insula: Links to neurological and psychiatric diseases. Front Hum Neurosci. 2013;7:14.CrossRefGoogle ScholarPubMed
Hébert-Seropian, B, Boucher, O, Sénéchal, C, et al. Does unilateral insular resection disturb personality? A study with epileptic patients. J Clin Neurosci. 2017;43:121–125.CrossRefGoogle ScholarPubMed
Jobst, BC, Gonzalez-Martinez, J, Isnard, J, et al. The insula and its epilepsies. Epilepsy Curr. 2019 Jan;19(1):11–21.Google Scholar
Market, MS, Fisher, RS. Neuromodulation – Science and practice in epilepsy: Vagus nerve stimulation, thalamic deep brain stimulation, and responsive neurostimulation. Expert Rev Neurother. 2019;19(1):17–29.Google Scholar
Skarpaas, TL, Jarosiewicz, B, Morrell, MJ. Brain-responsive neurostimulation for epilepsy (RNS® System). Epilepsy Res. 2019;153:68–70.CrossRefGoogle ScholarPubMed
Geller, EB. Responsive neurostimulation: Review of clinical trials and insights into focal epilepsy. Epilepsy Behav. 2018;88S:11–20.CrossRefGoogle ScholarPubMed
Ma, BB, Rao, VR. Responsive neurostimulation: Candidates and considerations. Epilepsy Behav. 2018 Nov;88:388–395.CrossRefGoogle ScholarPubMed
Morrell, MJ. RNS system in epilepsy study group: Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology. 2011 Sep 27;77(13):1295–1304.Google Scholar
Nair, D, System Investigators, RNS, Morrell, MJ. Nine-year prospective safety and effectiveness outcomes from the long-term treatment trial of the RNS® System. AES Annual Meeting Abstract Database; 2018; AESnet.org.CrossRefGoogle Scholar
Bergey, GK, Morrell, MJ, Mizrahi, EM, et al. Long-term treatment with responsive brain stimulation in adults with refractory partial seizures. Neurology. 2015;84(8):810–817.CrossRefGoogle ScholarPubMed
Heck, CN, King-Stephens, D, Massey, AD, et al. Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: Final results of the RNS System Pivotal Trial. Epilepsia. 2014;55(3):432–441.CrossRefGoogle ScholarPubMed
Devinsky, O, Friedman, D, Duckrow, RB, et al. Sudden unexpected death in epilepsy in patients treated with brain-responsive stimulation. Epilepsia. 2018;59:555–561.Google Scholar
Meador, KJ, Kapur, R, Loring, DW, et al. Quality of life and mood in patients with medically intractable epilepsy treated with targeted responsive neurostimulation. Epilepsy Behav. 2015 Apr;45:242–247.CrossRefGoogle ScholarPubMed
Loring, DW, Kapur, R, Meador, KJ, et al. Differential neuropsychological outcomes following targeted responsive neurostimulation for partial-onset epilepsy. Epilepsia. 2015 Nov;56(11):1836–1844.CrossRefGoogle ScholarPubMed
Jobst, BC, Kapur, R, Barkley, G, et al. Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas. Epilepsia. 2017;58(6):1005–1014.CrossRefGoogle ScholarPubMed
Smith, JR, Fountas, KN, Murro, AM, et al. Closed-loop stimulation in the control of focal epilepsy of insular origin. Stereotact Funct Neurosurg. 2010;88(5):281–287.Google Scholar
Chen, H, Dugan, P, Chong, DJ, et al. Application of RNS in refractory epilepsy: Targeting insula. Epilepsia Open. 2017;2(3):345–349.CrossRefGoogle ScholarPubMed
Gooneratne, IK, Green, AL, Dugan, P, et al. Comparing neurostimulation technologies in refractory focal-onset epilepsy. J Neurol Neurosurg Psychiatry. 2016 Nov;87(11):1174–1182.CrossRefGoogle ScholarPubMed
Wheless, JJ, Gienapp, AJ. Vagus nerve stimulation (VNS) therapy update. Epilepsy Behav. 2018 Nov;88S:2–10.CrossRefGoogle ScholarPubMed
Englot, DJ, Chang, EF, Auguste, KI. Vagus nerve stimulation for epilepsy: A meta-analysis of efficacy and predictors of response. J Neurosurg. 2011;115:248–255.CrossRefGoogle ScholarPubMed
Ben-Menachem, E. Vagus nerve stimulation, side effects, and long-term safety. J Clin Neurophysiol. 2001 Sep;18(5):415–418.CrossRefGoogle ScholarPubMed
Ryvlin, P, Gilliam, FG, Nguyen, DK, et al. The long-term effect of vagus nerve stimulation on quality of life in patients with pharmacoresistant focal epilepsy: The PuLsE (open prospective randomized long-term effectiveness) trial. Epilepsia. 2014;55:893–900.CrossRefGoogle ScholarPubMed
Vonck, K, Raedt, R, Naulaerts, J, et al. Vagus nerve stimulation … 24 years later! What do we know about the effects on cognition? Neurosci Biobehav Rev. 2014 Sep;45:63–71.CrossRefGoogle Scholar
Ryvlin, P, So, El, Gordon, CM, et al. Long-term surveillance of SUDEP in drug-resistant epilepsy patients treated with VNS therapy. Epilepsia. 2018;59(3):562–572.Google Scholar
Kuba, R, Novak, Z, Chrastina, J, et al. Comparing the effects of cortical resection and vagus nerve stimulation in patients with nonlesional extratemporal epilepsy. Epilepsy Behav. 2013;28(3):474–480.Google Scholar
Lehtimaki, K, Coenan, VA, Goncalves Ferreira, A, et al. The surgical approach to the anterior nucleus of the thalamus in patients with refractory epilepsy: Experience from the international multicenter registry (MORE). Neurosurgery. 2019;84(1):141–150.CrossRefGoogle Scholar
Salanova, V. Deep brain stimulation for epilepsy. Epilepsy Behav. 2018 Nov;88S:21–24.CrossRefGoogle ScholarPubMed
Li, MC, Cook, MJ. Deep brain stimulation for drug-resistant epilepsy. Epilepsia. 2018 Feb;59(2):273–290.Google Scholar
Fisher, R, Salanova, V, Witt, T, et al. Electrical stimulation of the anterior nucleus of the thalamus for treatment of refractory epilepsy. Epilepsia. 2010; 51(5):899–908.CrossRefGoogle ScholarPubMed
Sprengers, M, Vonck, K, Carrette, E, et al. Deep brain and cortical stimulation for epilepsy. Cochrane Database Syst Rev. 2017;7:CD008497.Google Scholar
Tröster, AI, Meador, KJ, Irwin, CP, et al. Memory and mood outcomes after anterior thalamic stimulation for refractory partial epilepsy. Seizure. 2017;45:133–141.Google Scholar
Lee, KJ, Shon, YM, Cho, CB. Long-term outcome of anterior thalamic nucleus stimulation for intractable epilepsy. Stereotact Funct Neurosurg. 2012;90:379–385.Google Scholar
Oh, YS, Kim, HJ, Lee, KJ, et al. Cognitive improvement after long-term electrical stimulation of bilateral anterior thalamic nucleus in refractory epilepsy patients. Seizure. 2012;22:183–187.Google Scholar
Voges, BR, Schmitt, FC, Hamel, W, et al. Deep brain stimulation of anterior nucleus thalami disrupts sleep in epilepsy patients. Epilepsia. 2015;56:e99–e103.CrossRefGoogle ScholarPubMed

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