Low frequency electrical stimulation through subdural electrodes in a case of refractory status epilepticus

Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Room 1-194, Los Angeles, CA 90095, USA.
Clinical Neurophysiology (Impact Factor: 2.98). 05/2006; 117(4):781-8. DOI: 10.1016/j.clinph.2005.12.010
Source: PubMed

ABSTRACT We delivered low frequency stimulation through subdural electrodes to suppress seizures in a case of refractory status epilepticus (RSE).
A 26-year-old female developed RSE after several days of febrile illness. Seizure control required continuous infusion of two anesthetics plus high doses of 2-4 enteral antiepileptic drugs. After 3 months of RSE, subdural strips were placed to determine surgical candidacy. Five independent ictal onset zones were identified. Because she was a poor candidate for epilepsy surgery and had a poor prognosis, the implanted subdural electrodes were used to administer 0.5 Hz stimulations to the ictal onset zones in 30 min trains daily for 7 consecutive days in an attempt to suppress seizures.
After 1 day of stimulation, one anesthetic agent was successfully discontinued. Seizures only returned by the 4th day when the second anesthetic had been reduced by 60%. Upon returning, seizures arose from only one of the 5 original ictal onset zones. Unfortunately, RSE persisted, and she eventually died.
In this case of RSE, low frequency stimulation through subdural electrodes transiently suppressed seizures from all but one ictal onset zone and allowed significant reduction in seizure medication.
Low frequency cortical stimulation may be useful in suppressing seizures.

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    ABSTRACT: Low- and high-frequency stimulation (LFS and HFS, respectively) have been, reported to modify seizure characteristics in rats. We here report effects of hippocampal LFS and HFS, applied at two or four sites in fully kindled rats. Rats were kindled through a hippocampal tetrode until the fully kindled state. Animals with, stable afterdischarge (AD) threshold were randomly assigned to 5 groups; stimulation at 1Hz (LFS) or, 130Hz (HFS) was continuously applied for 7 days at 2 or 4 intrahippocampal sites; a control, group received no stimulation. Four-contact stimulation was performed in a rotating fashion. Stimulation effects on AD threshold, AD duration and behavioral seizures were assessed. Four-contact LFS consistently increased AD threshold for a period of 2 days to 2 weeks, whereas 4-contact HFS significantly decreased AD duration 24hours following the stimulation period. No significant AD modification was observed with either 2-contact stimulation paradigms. No, behavioral alteration occurred in any group. These findings suggest that effects of hippocampal stimulation depend on frequency and topography of stimulus application. LFS and HFS had anti-epileptic effect on afterdischarges when applied in a rotating pattern. This supports concepts on patterned stimulation to result in desynchronization and anti-kindling effects.
    Epilepsy research 09/2013; DOI:10.1016/j.eplepsyres.2013.08.014 · 2.19 Impact Factor
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    ABSTRACT: Low frequency stimulation (LFS) is a potential alternative therapy for epilepsy. However, it seems that the anticonvulsant effects of LFS depend on its target sites in the brain. Thus, the present study was designed to compare the anticonvulsant effects of LFS administered to amygdala, piriform cortex and substantia nigra on amygdala kindling acquisition. In control group, rats were kindled in a chronic manner (one stimulation per 24 h). In other experimental groups, animals received low-frequency stimulation (8 packages at 100 s intervals, each package contained 200 monophasic square-wave pulses, 0.1 ms pulse duration at 1 Hz andAD threshold intensity) in amygdala, piriform cortex or substantia nigra 60 seconds after the kindling stimulation, the AD duration and daily seizure stages were recorded. The obtained results showed that administration of LFS in all three regions reduced electrical and behavioral parameters of the kindling procedure. However LFS has a stronger inhibitory effect on kindling development when applied in substantia nigra compared to the amygdala and piriform cortex which reinforce the view that the substantia nigra mediates a crucial role in amygdala-kindled seizures. LFS had also greater inhibitory effects when applied to the amygdala compared to piriform cortex. Thus, it may be suggested that antiepileptogenic effect of LFS depends on its target site and different brain areas exert different inhibitory effects on kindling acquisition according to the seizure focus.
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