Is Tech The Answer For Seizure Patients?

Is Tech The Answer For Seizure Patients?

According to the CDC, over 3.4 million Americans – or 1.2 percent of the U.S. population – suffer from some form of epilepsy. Medication keeps some of these people’s seizures under control. The medications’ side effects, however, often make it difficult to function normally, and at least 30 percent of patients don’t respond to anti-seizure medication at all.

Enter NeuroPace, Inc., a neuro-technology company based in Silicon Valley. It recently concluded a nine-year study on patients suffering from epilepsy using a tech gadget – not medication – to stymie the seizures.

The results? Over the course of the study, 75 percent of epileptic patients had at least a 50 percent reduction in seizures – and 33 percent had at least a 90 percent reduction! In addition, 28 percent had no seizures for over six months and 18 percent had no seizures for over a year. Patients did not report chronic stimulation side effects.

NeuroPace’s neuro-modulation study was the longest and largest for epileptics. The company evaluated 230 patients from 33 epilepsy centers across the United States. In addition to long-term seizure reduction, patients reported having a better quality of life in areas unrelated to epilepsy, and the device’s neural recordings provided doctors with critical information to better understand and, subsequently, treat seizures.

So how exactly does the technology work?

Neurons in the human brain constantly release electrical signals (otherwise known as brain activity). Misfired electrical signals can result in seizures. Anti-seizure medications remove, reduce, or alter excessive electrical activity so that faulty electrical signals aren’t “passed on” to the next batch of neurons, thus reducing the probability of seizures.

In contrast, NeuroPace’s Responsive Neurostimulation (RNS) System uses a computer interface technology device to treat the seizures at their source – and the device only goes into gear when the patient requires it. The RNS System uses a three-pronged approach. First, it detects and responds to a patient’s brain activity. Every patient’s brain is a little different, so doctors tailor the program to each patient’s unique brain activity.

Once programmed, the RNS System monitors a patient’s brainwaves and is ready to provide treatment whenever it detects unusual activity that can lead to a seizure, even if the patient is sleeping. Finally, once unusual brain activity is detected, the device responds with a series of electrical pulses or bursts of stimulation to stop the seizure and normalize the brainwaves before the seizure begins.

The RNS device, which is essentially a neuro-stimulator, is placed on the bone covering the brain. Once installed, it cannot be seen or felt. Tiny wires are positioned on one or two places atop the brain where seizure activity is likely to occur. The RNS System has a remote monitor used by patients to upload his or her data, as well as an RNS tablet and Patient Data Management System to enable doctors to better monitor patients. The device can always be turned off or removed if a patient doesn’t want it anymore.

During the course of the study, NeuroPace upgraded its RNS System. The 2.0 version has a battery life lasting 8.4 years, as opposed to the original’s 3.9 years. The amount of available memory for doctors to review patients’ brainwaves has also doubled.

The RNS System is available in epilepsy centers across the U.S. It is often used in conjunction with medication and is usually covered by insurance.

SOURCE: Article by B. Halperin for

New surgery treats epilepsy with deep-brain stimulation

New surgery treats epilepsy with deep-brain stimulation

Beginning Monday, patients with epilepsy will have a new option to reduce the number and severity of life-limiting seizures, avoiding radical surgery that removes a part of the brain.

Called deep-brain stimulation, the treatment uses electrodes implanted in the thalamus, a structure located near the center of the brain that receives information from the senses and sends signals to the cerebral cortex.


The electrodes are controlled by a device implanted in the chest, similar to a pacemaker, and patients have a remote-control device that can adjust the amount of stimulation or even turn it off for periods of time.
“It can have a very significant impact on the ability to live on their own, take a job, all the things that many of us take for granted,” said Dr. Jason Gerrard, director of stereotactic and functional neurosurgery at the Yale School of Medicine. Gerrard also is affiliated with the Yale Comprehensive Epilepsy Center at Yale New Haven Hospital, begun by Dr. Dennis Spencer, now chief of epilepsy surgery, 50 years ago.


“What we’re doing is attempting to change the activity of neurons in the brain through chronic neurostimulation,” Gerrard said.

Solomon Yi, a therapy representative for Medtronic, which is based in Minneapolis, said Yale New Haven Hospital, a Level 4 epilepsy center, is one of 30 “centers of excellence” that were chosen to begin using the neurostimulator for epilepsy. He said the system was “first approved for essential tremor, which was an action tremor, in 1997, Parkinson’s in 2002, then this year for epilepsy.”

The technique of implanting electrodes in the brain has been used for disorders including action tremors (which occur during bodily movement), Parkinson’s disease, dystonia (involuntary muscle contractions) and obsessive-compulsive disorder. But the Food and Drug Administration only approved the technique for epilepsy in April.

There are 2.2 million to 3 million epilepsy patients in the United States, according to the American Epilepsy Society, with one in 26 people suffering epileptic seizures during their lifetime. There are medications for the disorder, which the Epilepsy Foundation says control seizures in 70 percent of patients.

When the disorder is resistant to medication, it is known as refractory epilepsy, Gerrard said, but most people will try up to six or seven medications before they’ll even consider surgery because it is so invasive.

“Historically, we would attempt to localize the onset of the seizures and evaluate the patient to see if that part of the brain can be removed, and in some cases it can be,” Gerrard said. In others, the source of the epileptic seizures is “either difficult to nail down or starts in a part of the brain that cannot be removed,” he said.

Traditional surgery has been recommended once two medications have failed to help a patient, but “in reality, people are more willing to try that sixth, seventh, eighth medication rather than going for surgery,” Gerrard said. “I think that’s human nature.”

The younger a person is when they undergo surgery the better, but “right now our average patient who finally comes for surgical treatment is probably in their late 30s, early 40s,” Gerrard said.

The most common surgery, which Gerrard said has a 60 percent cure rate, is an anterior medial temporal lobectomy, which removes parts of the amygdala and hippocampus and can affect memory and cognition. In trials comparing surgery with multiple medications, the surgery was shown “to be far superior,” he said.

“We haven’t made any progress in getting people to consider surgery earlier in their treatment course,” he said. “We’re hoping … having a less invasive surgical option will help break down those barriers in having those patients consider surgery.”

Deep-brain stimulation is much less aggressive than traditional surgery. The neurostimulator device is implanted in the chest and two leads are brought under the skin to the top of the head, with one being inserted into each thalamus on either side of the brain. Each lead has four contacts. “You can stimulate any or all of them in any combination,” Gerrard said.

In the thalamus, there are clusters of neurons that control communication of sensory stimuli to other parts of the brain. The part of the thalamus that the electrodes target “is well connected to what is called the limbic system, which is one of the major networks that is involved in epilepsy, and so the idea is to modulate that whole system and reduce the seizures,” Gerrard said. The limbic system is involved in the emotions, memory and basic drives such as hunger.

While deep-brain stimulation has been used for other neurological disorders, “the process of going through FDA trials to get approval for the therapy takes many years,” he said. A major study, Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy, sponsored by Medtronic, developer of the neurostimulation device, was registered in January 2005 and results were first reported in March 2010. The subjects were “all patients who continued to have seizures despite multiple medications,” with a minimum of two seizures per month, Gerrard said. “Some patients have many more than that.”

“The outcomes … were pretty good, not as great as everybody had hoped,” and the device was approved in Europe but not in the United States. However, “they followed those patients over time and showed that the efficacy improved,” Gerrard said. After five years, up to 65 percent of patients responded to the stimulation. “With the long-term data they went back to the FDA … and got approval” in 2015.

The stimulator comes in two models, one operated by a lithium ion battery that must be replaced every three to five years and another that is rechargeable and lasts up to 12 years. The patient holds a recharging device to the chest to keep the stimulator going.

After the stimulator is implanted, programming it is done over time, with “adjustments made depending on any potential side effects patients are having” and how well it is working to reduce the number and severity of seizures. Each patient is given a programmer “that allows them to interact with the device,” Gerrard said. “It’s kind of like a parental programmer for the television. In some patients, as they become more familiar with the device and their stimulator … they may change their programs at home.”

In some patients, for example, reducing the number of seizures has the side effect of lowering the volume of their voice, so they may turn the device off during a family function so they can be heard, Gerrard said. It also needs to be turned off during an electrocardiogram, MRI and some dental procedures.

While the reduction in the number of seizures can be measured, whether their intensity is reduced is “more difficult to quantify,” Gerrard said. “Most people who are having seizures can’t tell you much about their seizures.”

He said “the majority of experts would agree that there is ongoing damage to the brain networks in people who are having seizures” and there is hope that reducing seizures through neurostimulation “can actually improve their cognitive functions.”

While there haven’t been many side effects found, “there is some work looking at whether the stimulator can affect the patient’s mood,” either heightening or lowering it, Gerrard said. “It seems to be more of a slow, long-term effect,” he said. “Not necessarily surprisingly, the fact that the brain networks that are involved in epilepsy” overlap with the networks “involved in neuropsychiatric disorders,” such as depression, anxiety and obsessive-compulsive disorder.

“If you look at patients with epilepsy, the existence of depression, anxiety in the patient population is more than 50 percent,” he said.

The surgery to implant the neurostimulator and its electrodes is conducted “in the MRI scanner so we can actually see the target we’re trying to hit and in real time see the electrodes go to that target,” he said.

SOURCE:  New Haven Register by E. Stannard

Implantable Device Provides New Treatment Option for Epilepsy Patients

Implantable Device Provides New Treatment Option for Epilepsy Patients

Richard Pollitt was at the end of his rope after years of suffering regular seizures, with some lasting five minutes and preventing him from working and enjoying his favorite pastimes. Desperate for relief after medications did not work, Pollitt had a small battery-powered device implanted in his skull to control seizures. Now he rarely has them.

Photo Credit: Houston Methodist
After experiencing four to five seizures a week for six years, Richard Pollitt, left, had a device implanted in his brain to help prevent seizures. The device provides data that allows his physician, Houston Methodist neurologist Amit Verma, M.D., right, to track the activity of his brain and the device to improve care.


Monthly brain cycles predict seizures in patients with epilepsy

Monthly brain cycles predict seizures in patients with epilepsy

Implanted electrodes reveal long-term patterns of seizure risk.


University of California San Francisco neurologists have discovered monthly cycles of brain activity linked to seizures in patients with epilepsy. The finding, published online January 8 in Nature Communications, suggests it may soon be possible for clinicians to identify when patients are at highest risk for seizures, allowing patients to plan around these brief but potentially dangerous events. (more…)

Device Shows Long-term Efficacy for Intractable Seizures

Device Shows Long-term Efficacy for Intractable Seizures

Almost three quarters of patients with medically intractable seizures who received neurostimulation with a novel device called the RNS System (NeuroPace Inc) had sustained seizure reduction at 8 years, new research shows.
Furthermore, the analysis found that almost a third of those receiving the RNS System had at least one 6-month period without seizures and that the treatment remained relatively safe over time. (more…)