Responsive neurostimulation leads targeting intracranial sites with ictal high‐frequency oscillation onset patterns are associated with better 2‐year seizure control outcomes.
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| Title: | Responsive neurostimulation leads targeting intracranial sites with ictal high‐frequency oscillation onset patterns are associated with better 2‐year seizure control outcomes. |
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| Authors: | Deng, Doris (AUTHOR), Jung, Brian (AUTHOR), Mnatsakanyan, Lilit (AUTHOR), Sazgar, Mona (AUTHOR), King‐Stephens, David (AUTHOR), Vadera, Sumeet (AUTHOR), Qing, Kurt Y. (AUTHOR) |
| Source: | Epilepsia (Series 4). May2026, Vol. 67 Issue 5, p2131-2144. 14p. |
| Subjects: | Seizures (Medicine), Brain stimulation, Neural stimulation, Electroencephalography, Epileptiform discharges, Epilepsy surgery, Frequencies of oscillating systems |
| Abstract: | Objective: Responsive neurostimulation (RNS) offers an effective and safe treatment for people living with refractory focal‐onset epilepsy. Many RNS candidates need intracranial electroencephalography (IEEG) monitoring to locate seizure‐onset zones (SOZs), which is a difficult procedure with variable yields. High‐frequency oscillations (HFOs) are a common ictal‐onset feature, and our study seeks to explore ictal HFOs as a marker for targeting RNS. Methods: We screened patients who underwent IEEG then RNS implantation at our center from 2015 to 2022. While blinded to outcomes, we analyzed IEEG using standard clinical software to detect ictal HFO‐onset patterns at the previously identified onsets. Then we examined RNS lead placement in relation to the SOZs and seizure control outcomes after 2 years post‐implantation. Results: A total of 62 patients received RNS during the study period. Excluding those patients with insufficient follow‐up and combined surgeries (RNS + resection/ablation), 33 patients remained. At 2 years, 26 (~78.8%) had ≥50% seizure reduction, and 7 (~21.2%) were free of debilitating seizures (super‐responders). We excluded an additional 8 patients due to having skipped IEEG and early explantation, leaving 25 study subjects. Ictal HFOs were present in all SOZs for 17 patients, and 14 patients (including all 7 super‐responders) had RNS leads implanted in all of these SOZs. When ictal HFOs were absent or not covered by RNS leads, the patients did not achieve seizure freedom. There was a statistically significant association between targeting SOZs with ictal HFO onsets and outcomes (Fisher's exact test p‐value 0.0078). Significance: Our results suggest that ictal HFOs provide additional localization value. Ictal HFOs represent very local epileptiform activity that may reflect closer proximity to epileptogenic tissue than conventional features such as spiking and slower rhythms. Because stimulation acts by focal tissue activation, increased targeting precision may be more important in RNS than surgeries such as resection or ablation. [ABSTRACT FROM AUTHOR] |
| Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Text: Availability: 0 |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 193814269 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Responsive neurostimulation leads targeting intracranial sites with ictal high‐frequency oscillation onset patterns are associated with better 2‐year seizure control outcomes. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Deng%2C+Doris%22">Deng, Doris</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Jung%2C+Brian%22">Jung, Brian</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mnatsakanyan%2C+Lilit%22">Mnatsakanyan, Lilit</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sazgar%2C+Mona%22">Sazgar, Mona</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22King‐Stephens%2C+David%22">King‐Stephens, David</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Vadera%2C+Sumeet%22">Vadera, Sumeet</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Qing%2C+Kurt+Y%2E%22">Qing, Kurt Y.</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Epilepsia+%28Series+4%29%22">Epilepsia (Series 4)</searchLink>. May2026, Vol. 67 Issue 5, p2131-2144. 14p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Seizures+%28Medicine%29%22">Seizures (Medicine)</searchLink><br /><searchLink fieldCode="DE" term="%22Brain+stimulation%22">Brain stimulation</searchLink><br /><searchLink fieldCode="DE" term="%22Neural+stimulation%22">Neural stimulation</searchLink><br /><searchLink fieldCode="DE" term="%22Electroencephalography%22">Electroencephalography</searchLink><br /><searchLink fieldCode="DE" term="%22Epileptiform+discharges%22">Epileptiform discharges</searchLink><br /><searchLink fieldCode="DE" term="%22Epilepsy+surgery%22">Epilepsy surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Frequencies+of+oscillating+systems%22">Frequencies of oscillating systems</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Objective: Responsive neurostimulation (RNS) offers an effective and safe treatment for people living with refractory focal‐onset epilepsy. Many RNS candidates need intracranial electroencephalography (IEEG) monitoring to locate seizure‐onset zones (SOZs), which is a difficult procedure with variable yields. High‐frequency oscillations (HFOs) are a common ictal‐onset feature, and our study seeks to explore ictal HFOs as a marker for targeting RNS. Methods: We screened patients who underwent IEEG then RNS implantation at our center from 2015 to 2022. While blinded to outcomes, we analyzed IEEG using standard clinical software to detect ictal HFO‐onset patterns at the previously identified onsets. Then we examined RNS lead placement in relation to the SOZs and seizure control outcomes after 2 years post‐implantation. Results: A total of 62 patients received RNS during the study period. Excluding those patients with insufficient follow‐up and combined surgeries (RNS + resection/ablation), 33 patients remained. At 2 years, 26 (~78.8%) had ≥50% seizure reduction, and 7 (~21.2%) were free of debilitating seizures (super‐responders). We excluded an additional 8 patients due to having skipped IEEG and early explantation, leaving 25 study subjects. Ictal HFOs were present in all SOZs for 17 patients, and 14 patients (including all 7 super‐responders) had RNS leads implanted in all of these SOZs. When ictal HFOs were absent or not covered by RNS leads, the patients did not achieve seizure freedom. There was a statistically significant association between targeting SOZs with ictal HFO onsets and outcomes (Fisher's exact test p‐value 0.0078). Significance: Our results suggest that ictal HFOs provide additional localization value. Ictal HFOs represent very local epileptiform activity that may reflect closer proximity to epileptogenic tissue than conventional features such as spiking and slower rhythms. Because stimulation acts by focal tissue activation, increased targeting precision may be more important in RNS than surgeries such as resection or ablation. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1002/epi.70115 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 14 StartPage: 2131 Subjects: – SubjectFull: Seizures (Medicine) Type: general – SubjectFull: Brain stimulation Type: general – SubjectFull: Neural stimulation Type: general – SubjectFull: Electroencephalography Type: general – SubjectFull: Epileptiform discharges Type: general – SubjectFull: Epilepsy surgery Type: general – SubjectFull: Frequencies of oscillating systems Type: general Titles: – TitleFull: Responsive neurostimulation leads targeting intracranial sites with ictal high‐frequency oscillation onset patterns are associated with better 2‐year seizure control outcomes. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Deng, Doris – PersonEntity: Name: NameFull: Jung, Brian – PersonEntity: Name: NameFull: Mnatsakanyan, Lilit – PersonEntity: Name: NameFull: Sazgar, Mona – PersonEntity: Name: NameFull: King‐Stephens, David – PersonEntity: Name: NameFull: Vadera, Sumeet – PersonEntity: Name: NameFull: Qing, Kurt Y. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 05 Text: May2026 Type: published Y: 2026 Identifiers: – Type: issn-print Value: 00139580 Numbering: – Type: volume Value: 67 – Type: issue Value: 5 Titles: – TitleFull: Epilepsia (Series 4) Type: main |
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