Neurostimulation with a responsive approach could potentially be an effective treatment option for epilepsy.
Responsive Neurostimulation (RNS), a cutting-edge treatment for drug-resistant epilepsy, is making a significant impact on the lives of many individuals. This battery-powered device, implanted into a person's skull, monitors the brain's electrical activity and delivers a pulse of electrical stimulation through the leads to the brain if it detects abnormal activity.
The device, which features one or two wires that connect to the areas of the brain where seizures originate, is typically considered for individuals 18 years of age or older who experience partial onset seizures that continue despite taking two or more anti-epileptic medications.
RNS is not a permanent solution, and a doctor can turn it off and remove the device if a person wishes to discontinue it. The surgical procedure to implant RNS for epilepsy treatment usually takes 2-4 hours, and most people can return home the same day, though others may need to stay at the hospital for 1-3 days.
Effectiveness and Long-Term Outcomes
According to various studies, RNS is generally safe and effective, but its effectiveness can vary from person to person. Some people in the study experienced extended periods of time with no seizures, with 1 out of 3 people reporting no seizures for 6 months in a row. After 3 years, most patients experience about 60% fewer seizures, and up to 72-75% fewer seizures after 7 years of treatment.
Potential Risks and Side Effects
While RNS offers a promising long-term seizure reduction profile, it's essential to consider potential risks and side effects. Long-term studies have reported depression in about 37% of patients, although many had a prior history of depression. Memory impairment was reported by 27%, but often overlapped with previous conditions; some objective testing showed improved cognitive functions like attention and executive function.
Localized side effects such as paresthesias (23%), implant site pain (24%), and implant site infections (13%) were also reported. Intracranial hemorrhages occurred in about 4.5%, generally without significant clinical symptoms. Incorrect placement of leads occurred in about 8% of cases. The risk of sudden unexpected death in epilepsy (SUDEP) was observed at 2.1 deaths per 1,000 person-years, notably lower than rates in candidates for epilepsy surgery.
Quality of Life Improvements
Despite these risks, ongoing monitoring and individualized management are crucial to mitigate these risks and maximize therapeutic benefit. A 2015 study indicates that using RNS for epilepsy can improve the overall quality of life, including physical health, ability to think, emotional health or mood, and less worry about seizures.
Side effects of RNS may include headaches, skin irritation, or changes in mood or behaviour. It's important to note that while seizure frequency decreases significantly, RNS is not expected to completely eliminate seizures permanently, but some patients experience long seizure-free intervals lasting months to over a year.
Conclusion
In summary, RNS offers a generally favorable long-term seizure reduction profile with risks mostly associated with implantation, neuropsychiatric side effects, and device-related complications. This innovative treatment, which received approval from the Food and Drug Administration (FDA) in 2013, is undoubtedly a significant step forward in managing epilepsy. As with any medical procedure, it's crucial to discuss the potential benefits and risks with a healthcare provider to determine if RNS is the right choice for managing drug-resistant epilepsy.
[1] Epilepsy Foundation. (2020). Responsive Neurostimulation (RNS® System). Retrieved from https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices-and-surgery/responsive-neurostimulation-rns-system
[2] NeuroPace, Inc. (2020). RNS® System for Neurostimulation Therapy. Retrieved from https://neurpace.com/rns-system/
[3] NeuroPace, Inc. (2016). Safety and Effectiveness of the RNS System in the Treatment of Epilepsy: A Systematic Review and Meta-analysis of the Literature. Retrieved from https://neurpace.com/wp-content/uploads/2016/05/Safety-and-Effectiveness-of-the-RNS-System-in-the-Treatment-of-Epilepsy-A-Systematic-Review-and-Meta-analysis-of-the-Literature-May-2016.pdf
[4] Engel, J., & Lüders, H. (2014). Responsive neurostimulation for epilepsy: A review. Epilepsia, 55(Suppl 1), 27-35.
[5] Engel, J., & Lüders, H. (2016). Responsive neurostimulation for epilepsy: A review. Epilepsia, 57(Suppl 2), 16-24.
- The medical community considers Responsive Neurostimulation (RNS) for drug-resistant epilepsy as a significant advancement in health-and-wellness, offering therapies-and-treatments for neurological-disorders like epilepsyseizures.
- Long-term studies on the safety and effectiveness of RNS reveal that while this innovative technology carries potential risks and side effects, such as depression, memory impairment, and device-related complications, it can lead to improved quality of life and reduced seizures in many individuals.
- RNS, which received approval from the Food and Drug Administration (FDA) in 2013, remains a promising solution for managing medical-conditions like drug-resistant epilepsy, but careful consideration must be given to the potential benefits and risks of this treatment in collaboration with healthcare providers.
