Nav: Home

Bringing neuromodulation therapies to drug-resistant epilepsy patients

June 25, 2019

BIRMINGHAM, Ala. - Despite medical and surgical advances to treat epilepsy, between 15 and 40 percent of patients continue to suffer from seizures. A significant service gap exists to bring new therapies -- called neuromodulation -- that could help many of these patients.

To fill this gap and improve seizure control for drug-resistant epilepsy, the University of Alabama at Birmingham created an epilepsy neuromodulation clinic. Now Sandipan Pati, M.D., assistant professor in the UAB Department of Neurology, and colleagues report on the outcomes provided by this specialized clinic during 19 months of operation, in a short research article published in Epilepsia Open.

Overall, Pati says, they found improved access for patients, good communication with referring physicians, achievement of expected outcomes for reducing or eliminating seizures, and the ability to train future providers in programming neuromodulation devices. This met their benchmark goals for the clinic of rapid accessibility for patients and referring physicians, despite the challenges of running a special clinic in a busy tertiary academic center like UAB Hospital.

In the study, UAB researchers report on two Food and Drug Administration-approved neuromodulation therapies -- vagal nerve stimulation, or VNS, and responsive neurostimulation, or RNS. Both use implantable stimulators that deliver electrical pulses to the brain or to the vagus nerve in the neck.

"There is a significant challenge in integrating these neuromodulation therapies in clinical practice," Pati said, "including appropriate patient selection, education for informed decision-making, availability of trained physicians to implant the device safely, and programming or troubleshooting the device to optimize therapy."

The neuromodulation devices need to be adjusted a number of times after implantation, a process called titration, to determine the most effective stimulation for each patient.

For patients receiving VNS at the UAB clinic, 12 out of 27 self?reported a more than 60 percent reduction in seizures at follow-ups, eight months or more after implantation; none were seizure-free. All of the VNS patients were from Alabama, many traveling considerable distances, up to 250 miles.

For the RNS, 11 of 16 patients self?reported a more than 60 percent reduction in seizures, and four were seizure?free. Most of the RNS patients were from Alabama, with many traveling considerable distances. Four were from the states of Arkansas, Mississippi and Florida.

All patients, Pati says, were scheduled in the clinic within two to four weeks, and stimulations were rapidly optimized. About 40 percent of patients participated in research, and 28 percent were referred for additional diagnostic studies. Additionally, 19 students and fellows were trained in programming the neurostimulators.

"Here, we have demonstrated the value of organizing a specialized clinic with a focus on rapid accessibility," Pati said. "Having a specialized neuromodulation clinic allows efficient management of resources, like scheduling field engineers to attend the clinic and avoiding multiple visits within a week. Also, one important aspect of titrating stimulation is patient tolerability, and the clinic provided rapid access within three weeks to manage stimulation?related side effects."

Poor seizure control, Pati notes, has been associated with poor quality of life, depression, anxiety and adverse side effects from medications.
Co-authors with Pati in the study, "Practice trends and the outcome of neuromodulation therapies in epilepsy: A single-center study," were Rabia Jamy, Manmeet Kaur, Diana Pizarro and Emilia Toth, UAB Department of Neurology.

University of Alabama at Birmingham

Related Seizures Articles:

Epilepsy: Seizures not forecastable as expected
Epileptic seizures can probably not be predicted by changes in brain wave patterns that were previously assumed to be characteristic precursors.
Predicting epileptic seizures might be more difficult than previously thought
By studying the brain dynamics of 28 subjects with epilepsy, scientists demonstrated there is no evidence for a previously suspected warning sign for seizures known as 'critical slowing down,' which refers to characteristic changes in the behavior of a complex system that approaches a theoretical tipping point; when this point is exceeded, there can be impactful and devastating changes.
Gene protective against fruit fly heat-induced seizures may explain some human seizures
Researchers identified a gene in fruit flies that helps prevent the hyperexcitability of specific neurons that trigger seizures.
Rethinking seizures associated with cardiac disease
Research from Washington University in St. Louis finds that mutations of a gene implicated in long QT syndrome in humans may trigger seizures because of their direct effects on certain classes of neurons in the brain -- independent from what the genetic mutations do to heart function.
UTSA reduces seizures by removing newborn neurons
Epileptic seizures happen in one of every 10 people who have experienced a traumatic brain injury (TBI).
Reducing seizures by removing newborn neurons
Removing new neurons born after a brain injury reduces seizures in mice, according to new research in JNeurosci.
Inducing seizures to stop seizures
Surgery is the only way to stop seizures in 30 per cent of patients with focal drug-resistant epilepsy.
New research could help predict seizures before they happen
A new study has found a pattern of molecules that appear in the blood before a seizure happens.
New drug could help treat neonatal seizures
A new drug that inhibits neonatal seizures in rodent models could open up new avenues for the treatment of epilepsy in human newborns.
Parents reassured febrile seizures following vaccination not dangerous
New University of Sydney research finds that febrile seizures after vaccination are rare, not serious and are no different to febrile seizures due to other causes such as from a virus.
More Seizures News and Seizures Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#543 Give a Nerd a Gift
Yup, you guessed it... it's Science for the People's annual holiday episode that helps you figure out what sciency books and gifts to get that special nerd on your list. Or maybe you're looking to build up your reading list for the holiday break and a geeky Christmas sweater to wear to an upcoming party. Returning are pop-science power-readers John Dupuis and Joanne Manaster to dish on the best science books they read this past year. And Rachelle Saunders and Bethany Brookshire squee in delight over some truly delightful science-themed non-book objects for those whose bookshelves are already full. Since...
Now Playing: Radiolab

An Announcement from Radiolab