Combined VNS-RNS Neuromodulation for Epilepsy
Author: Pouya Khankhanian1, Angelica M Lee2, Cornelia N Drees3, Barbara M Decker4, Danielle A Becker3
Affiliation:
1 Department of Neurology, Center for Neuro-engineering and Therapeutics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
2 Department of Neurology, Division of Epilepsy, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A.
3 Department of Neurology, Division of Epilepsy, Children's Hospital Colorado; University of Colorado, Denver, Aurora, Colorado, U.S.A.; and.
4 Department of Neurology, Division of Epilepsy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A.
Conference/Journal: J Clin Neurophysiol
Date published: 2022 Feb 1
Other:
Volume ID: 39 , Issue ID: 2 , Pages: e5-e9 , Special Notes: doi: 10.1097/WNP.0000000000000870. , Word Count: 154
The vagus nerve stimulator (VNS) and responsive nerve stimulator (RNS) are nonpharmacological devices approved for drug-resistant epilepsy. Vagus nerve stimulator was removed before placing an RNS in clinical trials. Two cases of bilateral mesial temporal epilepsy treated concurrently with VNS and bilateral mesial temporal RNS devices were reported. In each case, the VNS device was turned off temporarily, which allowed for a direct comparison of RNS recordings and efficacy with and without simultaneous VNS stimulation. Temporary VNS cessation lead to increased clinical and electrocorticographic seizures despite continued anti-seizure drugs and RNS stimulation. In one case, VNS eliminated seizures from one epileptogenic area, whereas VNS and RNS were required to treat seizures from the contralateral mesial temporal structure. In another case, VNS effectively decreased seizure spread to the symptomatogenic zone. These cases demonstrate synergistic neuromodulation with concurrent use of VNS and RNS in intractable bitemporal epilepsy.
PMID: 35130199 PMCID: PMC8822089 (available on 2023-02-01) DOI: 10.1097/WNP.0000000000000870
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