C Ákos Szabó1, Melissa De La Garza2, Robert Shade2, Alexander M Papanastassiou3, Peter Nathanielsz4. 1. Department of Neurology, UT Health San Antonio, San Antonio, TX, United States. Electronic address: szabo@uthscsa.edu. 2. Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States. 3. Department of Neurosurgery, UT Health San Antonio, San Antonio, TX, United States. 4. Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States; Department of Animal Science, University of Wyoming, Laramie, WY, United States.
Abstract
OBJECTIVE: To evaluate the efficacy of cortical responsive neurostimulation (CRN) in a male baboon with epilepsy and with genetic generalized epilepsy (GGE), as well as the alteration of seizure patterns and their circadian rhythms due to treatment. METHODS: The baboon was implanted with two subdural frontoparietal strips, bridging the medial central sulci bilaterally. Electrocorticography (ECoG) data were downloaded daily during a three-month baseline, then every 2-3 days over a five-month treatment period. Long episodes, reflecting ictal or interictal epileptic discharges, were also quantified. RESULTS: Twenty-three generalized tonic-clonic seizures (GTCS) and 2 episodes of nonconvulsive status epilepticus (NCSE) were recorded at baseline (median 8 events/month), whereas 26 GTCS were recorded under treatment (median 5/month). Similarly, daily indices of long episodes decreased from 0.46 at baseline to 0.29 with treatment. Ictal ECoG patterns and the circadian distribution of GTCS were also altered by RNS therapy. SIGNIFICANCE: This case study provides the proof-of-concept for RNS therapy in the baboon model of GGE. Cortical responsive neurostimulation (CRN) demonstrated a 38% median reduction in GTCS. Distinct ictal patterns were identified, which changed over the treatment period; the circadian pattern of his GTCS also shifted gradually from night to daytime with treatment. Future studies targeting the thalamic nuclei, or combining cortical and subcortical sites, may further improve detection and control of GTCS as well as other generalized seizure types. More broadly, this study demonstrates opportunities for evaluating seizure detection as well as chronic therapeutic interventions over long term in the baboon.
OBJECTIVE: To evaluate the efficacy of cortical responsive neurostimulation (CRN) in a male baboon with epilepsy and with genetic generalized epilepsy (GGE), as well as the alteration of seizure patterns and their circadian rhythms due to treatment. METHODS: The baboon was implanted with two subdural frontoparietal strips, bridging the medial central sulci bilaterally. Electrocorticography (ECoG) data were downloaded daily during a three-month baseline, then every 2-3 days over a five-month treatment period. Long episodes, reflecting ictal or interictal epileptic discharges, were also quantified. RESULTS: Twenty-three generalized tonic-clonic seizures (GTCS) and 2 episodes of nonconvulsive status epilepticus (NCSE) were recorded at baseline (median 8 events/month), whereas 26 GTCS were recorded under treatment (median 5/month). Similarly, daily indices of long episodes decreased from 0.46 at baseline to 0.29 with treatment. Ictal ECoG patterns and the circadian distribution of GTCS were also altered by RNS therapy. SIGNIFICANCE: This case study provides the proof-of-concept for RNS therapy in the baboon model of GGE. Cortical responsive neurostimulation (CRN) demonstrated a 38% median reduction in GTCS. Distinct ictal patterns were identified, which changed over the treatment period; the circadian pattern of his GTCS also shifted gradually from night to daytime with treatment. Future studies targeting the thalamic nuclei, or combining cortical and subcortical sites, may further improve detection and control of GTCS as well as other generalized seizure types. More broadly, this study demonstrates opportunities for evaluating seizure detection as well as chronic therapeutic interventions over long term in the baboon.
Authors: Philippa J Karoly; Daniel M Goldenholz; Dean R Freestone; Robert E Moss; David B Grayden; William H Theodore; Mark J Cook Journal: Lancet Neurol Date: 2018-09-12 Impact factor: 44.182
Authors: Laura A Cox; Anthony G Comuzzie; Lorena M Havill; Genesio M Karere; Kimberly D Spradling; Michael C Mahaney; Peter W Nathanielsz; Daniel P Nicolella; Robert E Shade; Saroja Voruganti; John L VandeBerg Journal: ILAR J Date: 2013
Authors: Charles Ákos Szabó; Margarita Akopian; David A González; Melissa A de la Garza; Melanie A Carless Journal: Epilepsia Date: 2019-10-08 Impact factor: 5.864
Authors: Barbara C Jobst; Ritu Kapur; Gregory L Barkley; Carl W Bazil; Michel J Berg; Gregory K Bergey; Jane G Boggs; Sydney S Cash; Andrew J Cole; Michael S Duchowny; Robert B Duckrow; Jonathan C Edwards; Stephan Eisenschenk; A James Fessler; Nathan B Fountain; Eric B Geller; Alica M Goldman; Robert R Goodman; Robert E Gross; Ryder P Gwinn; Christianne Heck; Aamr A Herekar; Lawrence J Hirsch; David King-Stephens; Douglas R Labar; W R Marsh; Kimford J Meador; Ian Miller; Eli M Mizrahi; Anthony M Murro; Dileep R Nair; Katherine H Noe; Piotr W Olejniczak; Yong D Park; Paul Rutecki; Vicenta Salanova; Raj D Sheth; Christopher Skidmore; Michael C Smith; David C Spencer; Shraddha Srinivasan; William Tatum; Paul Van Ness; David G Vossler; Robert E Wharen; Gregory A Worrell; Daniel Yoshor; Richard S Zimmerman; Tara L Skarpaas; Martha J Morrell Journal: Epilepsia Date: 2017-04-07 Impact factor: 5.864