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: 3.1). 05/2006; 117(4):781-8. DOI: 10.1016/j.clinph.2005.12.010
Source: PubMed


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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Available from: Noriko Salamon, Feb 25, 2015
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    • "Previous studies on rat hippocampus in vivo showed that LFS (0.1–10 Hz) had suppressive effect on high extracellular potassium and bicuculline caused seizure [13]. Applying LFS in epileptic zone in human brain suppressed epileptic activity [14]. In this experiment , the sustain effects of open loop low frequency electrical stimulation during 5 days period on spike–wave discharges in S1po area were scrutinized. "
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    ABSTRACT: Low frequency electrical stimulation has been revealed that as a potential cure in patient with drug resistant to epilepsy. This study tries to evaluate the effect of low frequency electrical stimulation (LFS) on absence seizure of perioral region primary somatosensory cortex (S1po). Eighteen male WAG/Rij rats were received LFS (3Hz, square wave, monophasic, 200μs, and 400μA) for 25min into S1po for a period of five days. There is 6 animals per group .The stimulating electrodes were implanted according to stereotaxic landmarks and EEG recording was obtained 30min before and after LFS to analyse frequency, number and duration of spike-wave discharges (SWD). The results showed that in animals with unilateral stimulating electrodes (Exp1) in first and second days and also in animals with bilateral stimulating electrodes (Exp2) in days 3rd and 4th. LFS had significant decrease effects (p<0.05) on mean number of SWD between pre-LFS. In comparison pre-LFS to post-LFS, mean of duration in Exp2 decreased significantly. In continuous application of LFS (5 days) only the data of first day was differently significant (p<0.05) but data of other days had no difference. Comparison of data between Exp1, Exp2 and control groups showed that the mean number of Exp1 was significantly different (p<0.05) and mean pick frequency in Exp2 was significantly decreased in comparison with Exp1 group (p<0.05). The LFS of S1po produces significant antiepileptic effect on absence seizure but it was not persistent till the next day and shows a short time effect.
    Pathophysiology 09/2013; 20(3). DOI:10.1016/j.pathophys.2013.08.006
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    • "In addition, previous experimental results using LFS have shown antiepileptic effects in clinical studies (Jerger & Schiff, 1995; Albensi et al., 2004; Morrell, 2011) and in animal studies (Velísek et al., 2002; Goodman et al., 2005; Schrader et al., 2006). However, the stimulation frequency and target capable of producing complete or near-complete suppression of seizure has not yet been found. "
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    ABSTRACT: To investigate the effects of low frequency stimulation (LFS) of a fiber tract for the suppression of spontaneous seizures in a rat model of human temporal lobe epilepsy. Stimulation electrodes were implanted into the ventral hippocampal commissure (VHC) in a rat post-status epilepticus (SE) model of human temporal lobe epilepsy (n = 7). Two recording electrodes were placed in the CA3 regions bilaterally and neural data were recorded for a minimum of 6 weeks. LFS (60 min train of 1 Hz biphasic square wave pulses, each 0.1 ms in duration and 200 μA in amplitude, followed by 15 min of rest) was applied to the VHC for 2 weeks, 24 h a day. The baseline mean seizure frequency of the study animals was 3.7 seizures per day. The seizures were significantly reduced by the application of LFS in every animal (n = 7). By the end of the 2-week period of stimulation, there was a significant, 90% (<1 seizure/day) reduction of seizure frequencies (p < 0.05) and a 57% reduction during the period following LFS (p < 0.05) when compared to baseline. LFS also resulted in a significant reduction of hippocampal interictal spike frequency (71%, p < 0.05), during 2 weeks of LFS session. The hippocampal histologic analysis showed no significant difference between rats that received LFS and SE induction and those that had received only SE-induction. None of the animals showed any symptomatic hemorrhage, infection, or complication. Low frequency stimulation applied at a frequency of 1 Hz significantly reduced both the excitability of the neural tissue as well as the seizure frequency in a rat model of human temporal lobe epilepsy. The results support the hypothesis that LFS of fiber tracts can be an effective method for the suppression of spontaneous seizures in a temporal lobe model of epilepsy in rats and could lead to the development of a new therapeutic modality for human patients with temporal lobe epilepsy.
    Epilepsia 12/2011; 53(1):147-56. DOI:10.1111/j.1528-1167.2011.03348.x · 4.57 Impact Factor
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    • "However, if such a mechanism is important, then antiepileptic drugs and anesthetics, through modifying synaptic plasticity (see for example Chang et al., 2010), could decrease the efficacy of such stimulation protocols. Low frequency stimulation has been used in a patient with multifocal status epilepticus who received 0.5 Hz stimulation via implanted subdural electrodes (Schrader et al., 2006). This was partially successful insofar as it enabled a decrease in anesthetics, but the eventual outcome was still poor. "
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    ABSTRACT: There is a long history of the use of brain stimulation in the treatment of epilepsy but relatively little experience for its use in status epilepticus. Electroconvulsive therapy, transcranial magnetic stimulation, subcortical and cortical stimulation have all been tried with varying degrees of success in single cases or small case series. It remains unclear, however, which brain areas should be stimulated and the parameters that should be used. Moreover, the aim (stopping status epilepticus) is different from preventing seizures and so the brain areas and parameters that are useful in epilepsy may not directly translate to the treatment of status epilepticus.
    Epilepsia 10/2011; 52 Suppl 8(s8):61-3. DOI:10.1111/j.1528-1167.2011.03240.x · 4.57 Impact Factor
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