A life without seizures
UF Health first in state to implant Responsive Neurostimulator System for epilepsy
By Dorothy Hagmajer
Epilepsy treatment just got a little more interesting.
The keyword is “little.” The RNS, or Responsive Neurostimulator System, is a small, battery-powered device designed to sense brain signals and subsequently detect seizure-onset patterns. Surgically placed within the skull, the RNS detects seizure activity and delivers small electrical pulses through leads, tiny wires containing electrodes that are placed in the area of the seizure’s focus, or point of origin. UF Health was the first health center in Florida to implant the device in a patient.
Patients take home a remote monitor, allowing them to download their personal diagnostic information to a website where their physician can retrieve and review this information.
“It learns the different wave forms over time, and the theory is that the stimulation given directly here is going to stop the seizure very quickly,” said Jean E. Cibula, M.D., an assistant professor in the department of neurology.
Equally as important as its technological makeup, however, are the implications of the RNS for those with previously untreatable cases of epilepsy.
“Patients are willing to do almost anything to become seizure-free because it’s a quality of life issue,” said Stephan Eisenschenk, M.D., an associate professor of neurology in the College of Medicine. “Treatment allows you get driving back, and that’s a huge factor for a lot of people.”
Epilepsy, a group of related disorders characterized by recurrent seizures, is relatively common, affecting about 2.3 million Americans, according to the Centers for Disease Control and Prevention. Worldwide, one in 10 people will have a seizure at some time in their lives, and 1 in 100 will have persistent seizures, according to the World Health Organization. While roughly half of people with epilepsy have their seizures successfully controlled with a drug, about 30 percent of people’s seizures are refractory, or unable to be controlled by medication. If medication doesn’t work, the next step is surgery.
“Some of those folks may have a lesion, like a tumor or malformation where the brain didn’t quite form right, in which case we may be able to remove it,” Cibula said.
Occasionally, however, the seizures’ focus is in an area of the brain where surgery is not an option, or the focus is mirrored in another location. In these cases, the RNS is in its element.
“The advantage of the RNS is that you are able to put in two electrodes and they can be in the same place or in two places at once,” said Steven N. Roper, M.D., the neurosurgeon who performed the implant at UF Health. “It’s a treatment for a very specific subset of patients that we couldn’t help before and those are patients for where we think we know the focus is.”
Of course, the RNS isn’t a perfect fit for everyone. For patients with seizures that are unable to be localized — the Vagus Nerve Stimulator is still the go-to device. The VNS works similarly to a pacemaker, periodically sending electrical impulses to the brain and preventing the abnormal electrical bursts that cause seizures in the first place.
But regardless of what treatment the patient is best suited to, the desire for a successful outcome is universal.
“Chronic illnesses are incredibly disruptive and affect every aspect of your life,” Cibula said. “And if you always have to have someone driving you, or need someone to stay home with you, it makes day-to-day life quite difficult.”