2020
Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy
Nair DR, Laxer KD, Weber PB, Murro AM, Park YD, Barkley GL, Smith BJ, Gwinn RP, Doherty MJ, Noe KH, Zimmerman RS, Bergey GK, Anderson WS, Heck C, Liu CY, Lee RW, Sadler T, Duckrow RB, Hirsch LJ, Wharen RE, Tatum W, Srinivasan S, McKhann GM, Agostini MA, Alexopoulos AV, Jobst BC, Roberts DW, Salanova V, Witt TC, Cash SS, Cole AJ, Worrell GA, Lundstrom BN, Edwards JC, Halford JJ, Spencer DC, Ernst L, Skidmore CT, Sperling MR, Miller I, Geller EB, Berg MJ, Fessler AJ, Rutecki P, Goldman AM, Mizrahi EM, Gross RE, Shields DC, Schwartz TH, Labar DR, Fountain NB, Elias WJ, Olejniczak PW, Villemarette-Pittman NR, Eisenschenk S, Roper SN, Boggs JG, Courtney TA, Sun FT, Seale CG, Miller KL, Skarpaas TL, Morrell MJ. Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology 2020, 95: 10.1212/wnl.0000000000010154. PMID: 32690786, PMCID: PMC7538230, DOI: 10.1212/wnl.0000000000010154.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedDepressive DisorderDrug Resistant EpilepsyElectric Stimulation TherapyEpilepsies, PartialFemaleFollow-Up StudiesHumansImplantable NeurostimulatorsIntracranial HemorrhagesMaleMemory DisordersMiddle AgedProspective StudiesProsthesis-Related InfectionsQuality of LifeRandomized Controlled Trials as TopicStatus EpilepticusSudden Unexpected Death in EpilepsySuicideTreatment OutcomeYoung AdultConceptsBrain-responsive neurostimulationQuality of lifeFocal onset seizuresAdverse eventsSeizure frequencyIntractable focal onset seizuresProspective open-label trialOverall QOLOpen-label trialSerious adverse eventsClass IV evidenceMedian percent reductionSudden unexplained deathMedian percent changeSeizure-free periodQOLIE-89SUDEP ratesLabel trialSeizure freedomEpilepsy ratesFocal seizuresOnset seizuresEpilepsy InventoryAcceptable safetyFocal epilepsyBeyond implantation effect? Long-term seizure reduction and freedom following intracranial monitoring without additional surgical interventions
Percy J, Zaveri H, Duckrow RB, Gerrard J, Farooque P, Hirsch LJ, Spencer DD, Sivaraju A. Beyond implantation effect? Long-term seizure reduction and freedom following intracranial monitoring without additional surgical interventions. Epilepsy & Behavior 2020, 111: 107231. PMID: 32615416, DOI: 10.1016/j.yebeh.2020.107231.Peer-Reviewed Original ResearchConceptsLong-term seizure freedomSeizure freedomSeizure frequencyElectrode implantationIntracranial studiesLong-term seizure reductionAdditional surgical interventionSeizure onset localizationIntracranial electroencephalogram monitoringSeizure reductionConsecutive patientsSurgical interventionEpileptogenic networksElectroencephalogram monitoringNeuromodulatory effectsRetrospective analysisIntracranial monitoringTransient improvementDepth electrodesPatientsYear 4ImplantationAdequate dataYears
2018
Sudden unexpected death in epilepsy in patients treated with brain‐responsive neurostimulation
Devinsky O, Friedman D, Duckrow RB, Fountain NB, Gwinn RP, Leiphart JW, Murro AM, Van Ness PC. Sudden unexpected death in epilepsy in patients treated with brain‐responsive neurostimulation. Epilepsia 2018, 59: 555-561. PMID: 29336029, DOI: 10.1111/epi.13998.Peer-Reviewed Original ResearchConceptsSudden unexpected deathDefinite SUDEPEpileptiform activityUnexpected deathBrain-responsive neurostimulationFrequent epileptiform activityDrug Administration approvalRNS SystemTime of deathSUDEP ratesWitnessed seizurePlacebo armResective surgerySUDEP riskClinical featuresImplant yearAdministration approvalClinical trialsEpilepsy patientsSUDEPPatientsSeizuresDrug studiesU.S. FoodDeath
2017
Brain‐responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy
Geller EB, Skarpaas TL, Gross RE, Goodman RR, Barkley GL, Bazil CW, Berg MJ, Bergey GK, Cash SS, Cole AJ, Duckrow RB, Edwards JC, Eisenschenk S, Fessler J, Fountain NB, Goldman AM, Gwinn RP, Heck C, Herekar A, Hirsch LJ, Jobst BC, King‐Stephens D, Labar DR, Leiphart JW, Marsh WR, Meador KJ, Mizrahi EM, Murro AM, Nair DR, Noe KH, Park YD, Rutecki PA, Salanova V, Sheth RD, Shields DC, Skidmore C, Smith MC, Spencer DC, Srinivasan S, Tatum W, Van Ness PC, Vossler DG, Wharen RE, Worrell GA, Yoshor D, Zimmerman RS, Cicora K, Sun FT, Morrell MJ. Brain‐responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy. Epilepsia 2017, 58: 994-1004. PMID: 28398014, DOI: 10.1111/epi.13740.Peer-Reviewed Original ResearchConceptsMesial temporal lobe epilepsyMesial temporal sclerosisSeizure-free periodTemporal lobe epilepsySeizure reductionAdverse eventsLobe epilepsyIntractable mesial temporal lobe epilepsySerious device-related adverse eventsIntractable partial-onset seizuresMedian percent seizure reductionMesial temporal lobe originBilateral mesial temporal lobe epilepsyDevice-related adverse eventsBrain-responsive neurostimulationImplant site infectionPercent seizure reductionPartial-onset seizuresProspective clinical trialsTemporal lobe originVagus nerve stimulationEffective treatment optionPercent of subjectsPreimplantation baselineTemporal sclerosisBrain‐responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas
Jobst BC, Kapur R, Barkley GL, Bazil CW, Berg MJ, Bergey GK, Boggs JG, Cash SS, Cole AJ, Duchowny MS, Duckrow RB, Edwards JC, Eisenschenk S, Fessler AJ, Fountain NB, Geller EB, Goldman AM, Goodman RR, Gross RE, Gwinn RP, Heck C, Herekar AA, Hirsch LJ, King‐Stephens D, Labar DR, Marsh WR, Meador KJ, Miller I, Mizrahi EM, Murro AM, Nair DR, Noe KH, Olejniczak PW, Park YD, Rutecki P, Salanova V, Sheth RD, Skidmore C, Smith MC, Spencer DC, Srinivasan S, Tatum W, Van Ness P, Vossler DG, Wharen RE, Worrell GA, Yoshor D, Zimmerman RS, Skarpaas TL, Morrell MJ. Brain‐responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas. Epilepsia 2017, 58: 1005-1014. PMID: 28387951, DOI: 10.1111/epi.13739.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultBrain MappingCerebral CortexDeep Brain StimulationDrug Resistant EpilepsyElectric Stimulation TherapyElectrodes, ImplantedElectroencephalographyEpilepsies, PartialEpilepsy, Complex PartialEpilepsy, Partial, MotorEpilepsy, Tonic-ClonicFeasibility StudiesFemaleFollow-Up StudiesHumansMaleMiddle AgedNeocortexYoung AdultConceptsSeizure-free periodSeizure reductionNeocortical onsetSeizure onsetNeocortical originIntractable partial-onset seizuresMedian percent seizure reductionBrain-responsive neurostimulationChronic neurologic deficitsPercent seizure reductionPrior epilepsy surgeryPartial-onset seizuresPercent of patientsProspective clinical trialsNormal MRI findingsVagus nerve stimulationEffective treatment optionEloquent cortical areasRate of infectionMagnetic resonance imagingPreimplantation baselineMRI lesionsAdverse eventsNeurologic deficitsPerioperative hemorrhage
2016
Regional and network relationship in the intracranial EEG second spectrum
Joshi RB, Gaspard N, Goncharova II, Duckrow RB, Duncan D, Gerrard JL, Spencer DD, Hirsch LJ, Zaveri HP. Regional and network relationship in the intracranial EEG second spectrum. Clinical Neurophysiology 2016, 127: 3485-3491. PMID: 27692590, DOI: 10.1016/j.clinph.2016.09.003.Peer-Reviewed Original ResearchElevated basal glutamate and unchanged glutamine and GABA in refractory epilepsy: Microdialysis study of 79 patients at the yale epilepsy surgery program
Çavuş I, Romanyshyn JC, Kennard JT, Farooque P, Williamson A, Eid T, Spencer SS, Duckrow R, Dziura J, Spencer DD. Elevated basal glutamate and unchanged glutamine and GABA in refractory epilepsy: Microdialysis study of 79 patients at the yale epilepsy surgery program. Annals Of Neurology 2016, 80: 35-45. PMID: 27129611, DOI: 10.1002/ana.24673.Peer-Reviewed Original ResearchConceptsGABA levelsEpilepsy patientsΓ-aminobutyric acid (GABA) neurotransmissionGlutamine levelsGABAergic antiepileptic drugsEpilepsy surgery programRefractory epilepsy patientsCommon pathological featureAberrant glutamateAnn NeurolNonepileptogenic cortexSeizure-onset sitesRefractory epilepsyBasal glutamateAntiepileptic drugsCortical lesionsMicrodialysis studyPatient groupInterictal levelsPathological featuresDifferent etiologiesNeocortical epilepsyGlutamate levelsSeizure generationElectroencephalogram evaluationThe relationship between seizures, interictal spikes and antiepileptic drugs
Goncharova II, Alkawadri R, Gaspard N, Duckrow RB, Spencer DD, Hirsch LJ, Spencer SS, Zaveri HP. The relationship between seizures, interictal spikes and antiepileptic drugs. Clinical Neurophysiology 2016, 127: 3180-3186. PMID: 27292227, DOI: 10.1016/j.clinph.2016.05.014.Peer-Reviewed Original ResearchConceptsFirst seizureSeizure occurrenceAED taperSpike rateEEG monitoringMarker of inhibitionIntracranial EEG monitoringOccurrence of seizuresScalp EEG monitoringConsecutive patientsAntiepileptic drugsDrug taperHigh spike ratesInterictal spikesSeizuresDay 4Intracranial electrodesPatientsAEDsSignificant relationshipProgressive change in sleep over multiple nights of intracranial EEG monitoring
Joshi RB, Gaspard N, Goncharova II, Pavlova M, Duckrow RB, Gerrard JL, Spencer DD, Hirsch LJ, Zaveri HP. Progressive change in sleep over multiple nights of intracranial EEG monitoring. Clinical Neurophysiology 2016, 127: 2302-2307. PMID: 27072103, DOI: 10.1016/j.clinph.2016.02.018.Peer-Reviewed Original Research50 Hz hippocampal stimulation in refractory epilepsy: Higher level of basal glutamate predicts greater release of glutamate
Cavus I, Widi GA, Duckrow RB, Zaveri H, Kennard JT, Krystal J, Spencer DD. 50 Hz hippocampal stimulation in refractory epilepsy: Higher level of basal glutamate predicts greater release of glutamate. Epilepsia 2016, 57: 288-297. PMID: 26749134, DOI: 10.1111/epi.13269.Peer-Reviewed Original ResearchConceptsBasal glutamate levelsRefractory epilepsyGlutamate effluxBasal glutamateGlutamate levelsElectrical stimulationEpileptic hippocampusGlutamate releaseSeizure groupHz stimulationBrain glutamate releaseHippocampus of patientsStimulation-induced increaseEpilepsy monitoring unitStimulation-induced changesEpileptogenic hippocampusInduced seizuresSeizure inductionSpontaneous seizuresInterictal levelsGlutamate increaseAtrophic hippocampusElectroencephalography evaluationHippocampal stimulationHippocampal electrodes
2015
Long-term treatment with responsive brain stimulation in adults with refractory partial seizures
Bergey GK, Morrell MJ, Mizrahi EM, Goldman A, King-Stephens D, Nair D, Srinivasan S, Jobst B, Gross RE, Shields DC, Barkley G, Salanova V, Olejniczak P, Cole A, Cash SS, Noe K, Wharen R, Worrell G, Murro AM, Edwards J, Duchowny M, Spencer D, Smith M, Geller E, Gwinn R, Skidmore C, Eisenschenk S, Berg M, Heck C, Van Ness P, Fountain N, Rutecki P, Massey A, O'Donovan C, Labar D, Duckrow RB, Hirsch LJ, Courtney T, Sun FT, Seale CG. Long-term treatment with responsive brain stimulation in adults with refractory partial seizures. Neurology 2015, 84: 810-817. PMID: 25616485, PMCID: PMC4339127, DOI: 10.1212/wnl.0000000000001280.Peer-Reviewed Original ResearchConceptsRefractory partial-onset seizuresPartial-onset seizuresRefractory partial seizuresOnset seizuresQuality of lifePartial seizuresResponsive neurostimulatorSerious device-related adverse eventsMedian percent seizure reductionGeneralized tonic-clonic seizuresOpen-label safety studyDevice-related adverse eventsImplant site infectionPercent seizure reductionResponsive brain stimulationClass IV evidenceTonic-clonic seizuresDirect cortical stimulationLong-term efficacyLong-term treatmentRNS SystemDirect neurostimulationSeizure reductionAdverse eventsSite infection
2014
The spatial and signal characteristics of physiologic high frequency oscillations
Alkawadri R, Gaspard N, Goncharova II, Spencer DD, Gerrard JL, Zaveri H, Duckrow RB, Blumenfeld H, Hirsch LJ. The spatial and signal characteristics of physiologic high frequency oscillations. Epilepsia 2014, 55: 1986-1995. PMID: 25470216, PMCID: PMC5123742, DOI: 10.1111/epi.12851.Peer-Reviewed Original ResearchConceptsPhysiologic high-frequency oscillationsSeizure onsetEpileptic networkNon-rapid eye movement sleepComprehensive Epilepsy CenterMesial temporal structuresEye movement sleepHigh-frequency oscillationsHighest HFO ratesFirst seizureInvasive evaluationEpilepsy centersIntracranial evaluationMovement sleepPerirolandic regionEpileptiform dischargesParietooccipital regionOccipital lobeEpileptic sitesPatientsNonepileptic regionsPhysiologic eventsFast ripplesHFO ratesLonger durationSubclinical seizures during intracranial EEG recording: Are they clinically significant?
Farooque P, Duckrow R. Subclinical seizures during intracranial EEG recording: Are they clinically significant? Epilepsy Research 2014, 108: 1790-1796. PMID: 25306063, DOI: 10.1016/j.eplepsyres.2014.09.020.Peer-Reviewed Original ResearchConceptsPoor surgical outcomesGood surgical outcomeSubclinical seizuresSurgical outcomesClinical seizuresIntracranial EEG recordingsGroup 2Group 1Extra-temporal lobe epilepsySeizure onset regionEEG recordingsExtra-temporal originResection correlatesSurgical resectionLobe epilepsyPoor outcomePrognostic valueClinical significanceBetter outcomesPatientsSeizuresEpileptic networkOnset zoneDifferent anatomical regionsEpilepsy databaseTwo‐year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: Final results of the RNS System Pivotal trial
Heck CN, King‐Stephens D, Massey AD, Nair DR, Jobst BC, Barkley GL, Salanova V, Cole AJ, Smith MC, Gwinn RP, Skidmore C, Van Ness PC, Bergey GK, Park YD, Miller I, Geller E, Rutecki PA, Zimmerman R, Spencer DC, Goldman A, Edwards JC, Leiphart JW, Wharen RE, Fessler J, Fountain NB, Worrell GA, Gross RE, Eisenschenk S, Duckrow RB, Hirsch LJ, Bazil C, O'Donovan CA, Sun FT, Courtney TA, Seale CG, Morrell MJ. 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: 432-441. PMID: 24621228, PMCID: PMC4233950, DOI: 10.1111/epi.12534.Peer-Reviewed Original ResearchConceptsIntractable partial-onset seizuresPartial-onset seizuresOpen-label periodResponsive stimulationSeizure focusSeizure reductionOnset seizuresSham stimulationIntractable partial onset epilepsySerious adverse event ratesFocal cortical stimulationPartial-onset epilepsyAdverse event ratesFrequency of seizuresMedian percent reductionAdditional treatment optionsSham stimulation groupBlinded periodMonth postimplantAdjunctive therapyAdverse eventsOnset epilepsyPivotal trialsCortical stimulationTreatment options
2013
7T MR spectroscopic imaging in the localization of surgical epilepsy
Pan JW, Duckrow RB, Gerrard J, Ong C, Hirsch LJ, Resor SR, Zhang Y, Petroff O, Spencer S, Hetherington HP, Spencer DD. 7T MR spectroscopic imaging in the localization of surgical epilepsy. Epilepsia 2013, 54: 1668-1678. PMID: 23895497, PMCID: PMC3938332, DOI: 10.1111/epi.12322.Peer-Reviewed Original ResearchConceptsSevere metabolic abnormalitiesLocalization-related epilepsyMR spectroscopic imagingN-acetyl aspartateComplete resectionMetabolic abnormalitiesBetter outcomesMedial temporal lobe epilepsyResection regionTemporal lobe epilepsyNAA/CrSeizure onset zoneSurgical resectionLobe epilepsySurgical approachSeizure localizationMetabolic dysfunctionInternational LeagueSurgical epilepsyGray matterEpilepsyResectionAbnormalitiesMRSI abnormalitiesOutcome predictionIntracranially recorded interictal spikes: Relation to seizure onset area and effect of medication and time of day
Goncharova II, Spencer SS, Duckrow RB, Hirsch LJ, Spencer DD, Zaveri HP. Intracranially recorded interictal spikes: Relation to seizure onset area and effect of medication and time of day. Clinical Neurophysiology 2013, 124: 2119-2128. PMID: 23856192, DOI: 10.1016/j.clinph.2013.05.027.Peer-Reviewed Original ResearchIntracranial EEG evaluation of relationship within a resting state network
Duncan D, Duckrow RB, Pincus SM, Goncharova I, Hirsch LJ, Spencer DD, Coifman RR, Zaveri HP. Intracranial EEG evaluation of relationship within a resting state network. Clinical Neurophysiology 2013, 124: 1943-1951. PMID: 23790525, DOI: 10.1016/j.clinph.2013.03.028.Peer-Reviewed Original ResearchConceptsDefault mode networkIntracranial EEG evaluationMode networkLocalization-related epilepsyCross-approximate entropyNeuronal involvementHemodynamic measurementsIntracranial EEG recordingsEEG evaluationBackground activityGamma powerFMRI studyIntracranial EEGBrain activityPatientsEEG recordingsLow levelsT2EpilepsyMagnitude squared coherenceT1
2012
Metabolic networks in epilepsy by MR spectroscopic imaging
Pan JW, Spencer DD, Kuzniecky R, Duckrow RB, Hetherington H, Spencer SS. Metabolic networks in epilepsy by MR spectroscopic imaging. Acta Neurologica Scandinavica 2012, 126: 411-420. PMID: 22574807, PMCID: PMC3600585, DOI: 10.1111/j.1600-0404.2012.01665.x.Peer-Reviewed Original ResearchConceptsMTLE patientsBasal gangliaEpileptic networkMesial temporal lobe epilepsy patientsTemporal lobe epilepsy patientsLimbic seizure propagationBilateral basal gangliaNAA/CrMR spectroscopicIpsilateral insulaSeizure propagationBilateral hippocampusEpilepsy patientsHuman studiesIndependent factorsPatientsNeuronal functionThalamusGangliaEpilepsyInsulaFactor analysisFactorsHippocampusInjury
2010
A prospective study of loss of consciousness in epilepsy using virtual reality driving simulation and other video games
Yang L, Morland TB, Schmits K, Rawson E, Narasimhan P, Motelow JE, Purcaro MJ, Peng K, Raouf S, DeSalvo MN, Oh T, Wilkerson J, Bod J, Srinivasan A, Kurashvili P, Anaya J, Manza P, Danielson N, Ransom CB, Huh L, Elrich S, Padin-Rosado J, Naidu Y, Detyniecki K, Hamid H, Farooque P, Astur R, Xiao B, Duckrow RB, Blumenfeld H. A prospective study of loss of consciousness in epilepsy using virtual reality driving simulation and other video games. Epilepsy & Behavior 2010, 18: 238-246. PMID: 20537593, PMCID: PMC2914099, DOI: 10.1016/j.yebeh.2010.04.011.Peer-Reviewed Original ResearchConceptsVideo gamesVirtual realityComputer-based tasksDaily lifePerformance dataProspective studyEssential partGameContinuous video/EEG monitoringVideo/EEG monitoringTraffic accidentsSimulatorNetworkTaskNormal daily lifeSeizure typesDrivingEEG monitoringSeizuresDriving impairmentPatientsImpair consciousnessSpecific typesAnatomical networksReality
2009
Spatial distribution of intracranially recorded spikes in medial and lateral temporal epilepsies
Goncharova II, Zaveri HP, Duckrow RB, Novotny EJ, Spencer SS. Spatial distribution of intracranially recorded spikes in medial and lateral temporal epilepsies. Epilepsia 2009, 50: 2575-2585. PMID: 19674048, DOI: 10.1111/j.1528-1167.2009.02258.x.Peer-Reviewed Original ResearchConceptsMedial temporal structuresInterictal spikesLT patientsCortical areasNeocortical seizure onsetsSleep-related increaseSpike rateLateral temporal epilepsyExtratemporal areasTemporal epilepsySeizure onsetIntracranial monitoringLT groupMT groupPatientsFrontal spikesSeizuresGreater numberSleepGroupTemporal structureEpilepsySpikes