Browsing by Author "Jobst, Barbara C."

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    Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy
    (Wiley, 2017-06) Geller, Eric B.; Skarpass, Tara L.; Gross, Robert E.; Goodman, Robert R.; Barkley, Gregory L.; Bazil, Carl W.; Berg, Michael J.; Bergey, Gregory K.; Cash, Sydney S.; Cole, Andrew J.; Duckrow, Robert B.; Edwards, Jonathan C.; Eisenschenk, Stephan; Fessler, James; Fountain, Nathan B.; Goldman, Alicia M.; Gwinn, Ryder P.; Heck, Christianne; Herekar, Aamar; Hirsch, Lawrence J.; Jobst, Barbara C.; King-Stephens, David; Labar, Douglas R.; Leiphart, James W.; Marsh, W. Richard; Meador, Kimford J.; Mizrahi, Eli M.; Murro, Anthony M.; Nair, Dileep R.; Noe, Katherine H.; Park, Yong D.; Rutecki, Paul A.; Salanova, Vicenta; Sheth, Raj D.; Shields, Donald C.; Skidmore, Christopher; Smith, Michael C.; Spencer, David C.; Srinivasan, Shraddha; Tatum, William; Van Ness, Paul C.; Vossler, David G.; Wharen, Robert E., Jr.; Worrell, Gregory A.; Yoshor, Daniel; Zimmerman, Richard S.; Cicora, Kathy; Sun, Felice T.; Morrell, Martha J.; Neurology, School of Medicine
    Objective Evaluate the seizure-reduction response and safety of mesial temporal lobe (MTL) brain-responsive stimulation in adults with medically intractable partial-onset seizures of mesial temporal lobe origin. Methods Subjects with mesial temporal lobe epilepsy (MTLE) were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2–6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. Results There were 111 subjects with MTLE; 72% of subjects had bilateral MTL onsets and 28% had unilateral onsets. Subjects had one to four leads placed; only two leads could be connected to the device. Seventy-six subjects had depth leads only, 29 had both depth and strip leads, and 6 had only strip leads. The mean follow-up was 6.1 ± (standard deviation) 2.2 years. The median percent seizure reduction was 70% (last observation carried forward). Twenty-nine percent of subjects experienced at least one seizure-free period of 6 months or longer, and 15% experienced at least one seizure-free period of 1 year or longer. There was no difference in seizure reduction in subjects with and without mesial temporal sclerosis (MTS), bilateral MTL onsets, prior resection, prior intracranial monitoring, and prior vagus nerve stimulation. In addition, seizure reduction was not dependent on the location of depth leads relative to the hippocampus. The most frequent serious device-related adverse event was soft tissue implant-site infection (overall rate, including events categorized as device-related, uncertain, or not device-related: 0.03 per implant year, which is not greater than with other neurostimulation devices). Significance Brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior MTL resection.
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    Brain-responsive neurostimulation in patients with medically intractable seizures arising from eloquent and other neocortical areas
    (Wiley, 2017-06) Jobst, Barbara C.; Kapur, Ritu; Barkley, Gregory L.; Bazil, Carl W.; Berg, Michel J.; Bergey, Gregory K.; Boggs, Jane G.; Cash, Sydney S.; Cole, Andrew J.; Duchowny, Michael S.; Duckrow, Robert B.; Edwards, Jonathan C.; Eisenschenk, Stephan; Fessler, A. James; Fountain, Nathan B.; Geller, Eric B.; Goldman, Alica M.; Goodman, Robert R.; Gross, Robert E.; Gwinn, Ryder P.; Heck, Christianne; Herekar, Aamr A.; Hirsch, Lawrence J.; King-Stephens, David; Labar, Douglas R.; Marsh, W. R.; Meador, Kimford J.; Miller, Ian; Mizrahi, Eli M.; Murro, Anthony M.; Nair, Dileep R.; Noe, Katherine H.; Olejniczak, Piotr W.; Park, Yong D.; Rutecki, Paul; Salanova, Vicenta; Sheth, Raj D.; Skidmore, Christopher; Smith, Michael C.; Spencer, David C.; Srinivasan, Shraddha; Tatum, William; Van Ness, Paul; Vossler, David G.; Wharen, Robert E., Jr.; Worrell, Gregory A.; Yoshor, Daniel; Zimmerman, Richard S.; Skarpass, Tara L.; Morrell, Martha J.; Neurology, School of Medicine
    Objective Evaluate the seizure-reduction response and safety of brain-responsive stimulation in adults with medically intractable partial-onset seizures of neocortical origin. Methods Patients with partial seizures of neocortical origin were identified from prospective clinical trials of a brain-responsive neurostimulator (RNS System, NeuroPace). The seizure reduction over years 2–6 postimplantation was calculated by assessing the seizure frequency compared to a preimplantation baseline. Safety was assessed based on reported adverse events. Additional analyses considered safety and seizure reduction according to lobe and functional area (e.g., eloquent cortex) of seizure onset. Results There were 126 patients with seizures of neocortical onset. The average follow-up was 6.1 implant years. The median percent seizure reduction was 70% in patients with frontal and parietal seizure onsets, 58% in those with temporal neocortical onsets, and 51% in those with multilobar onsets (last observation carried forward [LOCF] analysis). Twenty-six percent of patients experienced at least one seizure-free period of 6 months or longer and 14% experienced at least one seizure-free period of 1 year or longer. Patients with lesions on magnetic resonance imaging (MRI; 77% reduction, LOCF) and those with normal MRI findings (45% reduction, LOCF) benefitted, although the treatment response was more robust in patients with an MRI lesion (p = 0.02, generalized estimating equation [GEE]). There were no differences in the seizure reduction in patients with and without prior epilepsy surgery or vagus nerve stimulation. Stimulation parameters used for treatment did not cause acute or chronic neurologic deficits, even in eloquent cortical areas. The rates of infection (0.017 per patient implant year) and perioperative hemorrhage (0.8%) were not greater than with other neurostimulation devices. Significance Brain-responsive stimulation represents a safe and effective treatment option for patients with medically intractable epilepsy, including adults with seizures of neocortical onset, and those with onsets from eloquent cortex.
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    Long-term seizure, cognitive, and psychiatric outcome following trans–middle temporal gyrus amygdalohippocampectomy and standard temporal lobectomy
    (American Association of Neurological Surgeons, 2013) Bujarski, Krzysztof A.; Hirashima, Fuyuki; Roberts, David W.; Jobst, Barbara C.; Gilbert, Karen L.; Roth, Robert M.; Flashman, Laura A.; McDonald, Brenna C.; Saykin, Andrew J.; Scott, Rod C.; Dinnerstein, Eric; Preston, Julie; Williamson, Peter D.; Thadani, Vijay M.; Psychiatry, School of Medicine
    Object: Previous comparisons of standard temporal lobectomy (STL) and selective amygdalohippocampectomy (SelAH) have been limited by inadequate long-term follow-up, variable definitions of favorable outcome, and inadequate consideration of psychiatric comorbidities. Methods: The authors performed a retrospective analysis of seizure, cognitive, and psychiatric outcomes in a noncontemporaneous cohort of 69 patients with unilateral refractory temporal lobe epilepsy and MRI evidence of mesial temporal sclerosis after either an STL or an SelAH and examined seizure, cognitive, and psychiatric outcomes. Results: The mean duration of follow-up for STL was 9.7 years (range 1-18 years), and for trans-middle temporal gyrus SelAH (mtg-SelAH) it was 6.85 years (range 1-15 years). There was no significant difference in seizure outcome when "favorable" was defined as time to loss of Engel Class I or II status; better seizure outcome was seen in the STL group when "favorable" was defined as time to loss of Engel Class IA status (p=0.034). Further analysis revealed a higher occurrence of seizures solely during attempted medication withdrawal in the mtg-SelAH group than in the STL group (p=0.016). The authors found no significant difference in the effect of surgery type on any cognitive and most psychiatric variables. Standard temporal lobectomy was associated with significantly higher scores on assessment of postsurgical paranoia (p=0.048). Conclusions: Overall, few differences in seizure, cognitive, and psychiatric outcome were found between STL and mtg-SelAH on long-term follow-up. Longer exposure to medication side effects after mtg-SelAH may adversely affect quality of life but is unlikely to cause additional functional impairment. In patients with high levels of presurgical psychiatric disease, mtg-SelAH may be the preferred surgery type.