Browsing by Author "Salanova, Vicenta"

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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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    Lateralization of mesial temporal lobe epilepsy with chronic ambulatory electrocorticography
    (Wiley Blackwell (Blackwell Publishing), 2015-06) King-Stephens, David; Mirro, Emily; Weber, Peter B.; Laxer, Kenneth D.; Van Ness, Paul C.; Salanova, Vicenta; Spencer, David C.; Heck, Christianne N.; Goldman, Alica; Jobst, Barbara; Shields, Donald C.; Bergey, Gregory K.; Eisenschenk, Stephan; Worrell, Gregory A.; Rossi, Marvin A.; Gross, Robert E.; Cole, Andrew J.; Sperling, Michael R.; Nair, Dileep R.; Gwinn, Ryder P.; Park, Yong D.; Rutecki, Paul A.; Fountain, Nathan B.; Wharen, Robert E.; Hirsch, Lawrence J.; Miller, Ian O.; Barkley, Gregory L.; Edwards, Jonathan C.; Geller, Eric B.; Berg, Michel J.; Sadler, Toni L.; Sun, Felice T.; Morrell, Martha J.; Department of Neurology, IU School of Medicine
    OBJECTIVE: Patients with suspected mesial temporal lobe (MTL) epilepsy typically undergo inpatient video-electroencephalography (EEG) monitoring with scalp and/or intracranial electrodes for 1 to 2 weeks to localize and lateralize the seizure focus or foci. Chronic ambulatory electrocorticography (ECoG) in patients with MTL epilepsy may provide additional information about seizure lateralization. This analysis describes data obtained from chronic ambulatory ECoG in patients with suspected bilateral MTL epilepsy in order to assess the time required to determine the seizure lateralization and whether this information could influence treatment decisions. METHODS: Ambulatory ECoG was reviewed in patients with suspected bilateral MTL epilepsy who were among a larger cohort with intractable epilepsy participating in a randomized controlled trial of responsive neurostimulation. Subjects were implanted with bilateral MTL leads and a cranially implanted neurostimulator programmed to detect abnormal interictal and ictal ECoG activity. ECoG data stored by the neurostimulator were reviewed to determine the lateralization of electrographic seizures and the interval of time until independent bilateral MTL electrographic seizures were recorded. RESULTS: Eighty-two subjects were implanted with bilateral MTL leads and followed for 4.7 years on average (median 4.9 years). Independent bilateral MTL electrographic seizures were recorded in 84%. The average time to record bilateral electrographic seizures in the ambulatory setting was 41.6 days (median 13 days, range 0-376 days). Sixteen percent had only unilateral electrographic seizures after an average of 4.6 years of recording. SIGNIFICANCE: About one third of the subjects implanted with bilateral MTL electrodes required >1 month of chronic ambulatory ECoG before the first contralateral MTL electrographic seizure was recorded. Some patients with suspected bilateral MTL seizures had only unilateral electrographic seizures. Chronic ambulatory ECoG in patients with suspected bilateral MTL seizures provides data in a naturalistic setting, may complement data from inpatient video-EEG monitoring, and can contribute to treatment decisions.
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    Left Cervical Vagal Nerve Stimulation Reduces Skin Sympathetic Nerve Activity in Patients with Drug Resistant Epilepsy
    (Elsevier, 2017) Yuan, Yuan; Hassel, Jonathan L.; Doytchinova, Anisiia; Adams, David; Wright, Keith C.; Meshberger, Chad; Chen, Lan S.; Guerra, Maria P.; Shen, Changyu; Lin, Shien-Fong; Everett, Thomas H., IV; Salanova, Vicenta; Chen, Peng-Sheng; Department of Medicine, School of Medicine
    Background We recently reported that skin sympathetic nerve activity (SKNA) can be used to estimate sympathetic tone in humans. In animal models, vagal nerve stimulation (VNS) can damage the stellate ganglion, reduce stellate ganglion nerve activity, and suppress cardiac arrhythmia. Whether VNS can suppress sympathetic tone in humans remains unclear. Objective The purpose of this study was to test the hypothesis that VNS suppresses SKNA in patients with drug-resistant epilepsy. Methods ECG patch electrodes were used to continuously record SKNA in 26 patients with drug-resistant epilepsy who were admitted for video electroencephalographic monitoring. Among them, 6 (2 men, age 40 ± 11 years) were previously treated with VNS and 20 (7 men, age 37 ± 8 years) were not. The signals from ECG leads I and II were filtered to detect SKNA. Results VNS had an on-time of 30 seconds and off-time of 158 ± 72 seconds, with output of 1.92 ± 0.42 mA at 24.17 ± 2.01 Hz. Average SKNA during VNS off-time was 1.06 μV (95% confidence interval [CI] 0.93–1.18) in lead I and 1.13 μV (95% CI 0.99–1.27) in lead II, which was significantly lower than 1.38 μV (95% CI 1.01–1.75; P = .036) and 1.38 μV (95% CI 0.98–1.78; P = .035) in the control group, respectively. Heart rate was 65 bpm (95% CI 59–71) in the VNS group, which was significantly lower than 77 bpm (95% CI 71–83) in the control group. Conclusion Patients with VNS had significantly lower SKNA than those without VNS.
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    Simultaneous noninvasive recording of skin sympathetic nerve activity and electrocardiogram
    (Elsevier, 2017-01) Doytchinova, Anisiia; Hassel, Jonathan L.; Yuan, Yuan; Lin, Hongbo; Yin, Dechun; Adams, David; Straka, Susan; Wright, Keith; Smith, Kimberly; Wagner, David; Shen, Changyu; Salanova, Vicenta; Meshberger, Chad; Chen, Lan S.; Kincaid, John C.; Coffey, Arthur; Wu, Gang; Li, Yan; Kovacs, Richard J.; Everett, Thomas H., IV; Victor, Ronald; Cha, Yong-Mei; Lin, Shien-Fong; Chen, Peng-Sheng; Medicine, School of Medicine
    BACKGROUND: Sympathetic nerve activity is important to cardiac arrhythmogenesis. OBJECTIVE: The purpose of this study was to develop a method for simultaneous noninvasive recording of skin sympathetic nerve activity (SKNA) and electrocardiogram (ECG) using conventional ECG electrodes. This method (neuECG) can be used to adequately estimate sympathetic tone. METHODS: We recorded neuECG signals from the skin of 56 human subjects. The signals were low-pass filtered to show the ECG and high-pass filtered to show nerve activity. Protocol 1 included 12 healthy volunteers who underwent cold water pressor test and Valsalva maneuver. Protocol 2 included 19 inpatients with epilepsy but without known heart diseases monitored for 24 hours. Protocol 3 included 22 patients admitted with electrical storm and monitored for 39.0 ± 28.2 hours. Protocol 4 included 3 patients who underwent bilateral stellate ganglion blockade with lidocaine injection. RESULTS: In patients without heart diseases, spontaneous nerve discharges were frequently observed at baseline and were associated with heart rate acceleration. SKNA recorded from chest leads (V1-V6) during cold water pressor test and Valsalva maneuver (protocol 1) was invariably higher than during baseline and recovery periods (P < .001). In protocol 2, the average SKNA correlated with heart rate acceleration (r = 0.73 ± 0.14, P < .05) and shortening of QT interval (P < .001). Among 146 spontaneous ventricular tachycardia episodes recorded in 9 patients of protocol 3, 106 episodes (73%) were preceded by SKNA within 30 seconds of onset. Protocol 4 showed that bilateral stellate ganglia blockade by lidocaine inhibited SKNA. CONCLUSION: SKNA is detectable using conventional ECG electrodes in humans and may be useful in estimating sympathetic tone.