Implanted Neurostimulators Not Only Controls Epileptic Seizures But Also Reduces Comorbid Neuropsychiatric Symptoms
Source: Thailand Medical News Jan 03, 2020 4 years, 10 months, 2 weeks, 4 days, 8 hours, 42 minutes ago
Individuals with drug-resistant
epilepsy also can have deleterious
neuropsychiatric symptoms like anxiety, depression, psychosis and impaired memory. These have negative impacts on quality of life, and there is an unmet need to improve therapy for such patients. Diagnosing and monitoring such neurobehavioral symptoms is challenging because their presentation can overlap with
seizures.
Dr Sandipan Pati, M.D., and colleagues at the University of Alabama at Birmingham now report cases of five patients who found better treatments for those symptoms using data collected while the patients were at home from
implanted neurostimulators placed in their brains to control their
epileptic seizures.This is an extra benefit from the
implanted Responsive
Neurostimulator Systems, due to the system's ability to record brain electrocorticography data initiated when a patient senses an anxiety or panic attack.
This new data is key to showing whether the
neuropsychiatric comorbidity began before, during or after an
epileptic seizure. This guides medication or therapy changes that can reduce the negative symptoms caused by attacks that initiate outside of
seizures, including psychogenic nonepileptic
seizures. The only other way to get this useful information is video-electroencephalography in an inpatient clinic, with stays that typically last three to five days.
Dr Pati told
Thailand Medical News, "Treating these patients can be challenging, and one reason for this is that sometime seizures can mimic anxiety and panic attacks, or psychosis. Seizure-induced anxiety or psychosis is treated with anti-seizure medications, while 'pure' psychosis is treated with anti-psychotic medications. This study will be attractive for patients, as anxiety or depression is a common problem in
epilepsy, and patients get frustrated as they think we are always focused on treating seizures and not depression."
Dr Pati, an Associate Professor in the UAB Department of Neurology, leads an epilepsy neuromodulation clinic at UAB to improve seizure control for drug-resistant
epilepsy.
If a patient feels onset of a
neuropsychiatric incident, he or she can use a magnet to initiate brain recording, with the prior minute of signals retained. They then can transfer the data to a password-protected laptop, and physicians can review the data to guide therapies.
In the group of 21 patients with
implanted neurostimulators studied by Dr Pati and colleagues, there were five patients with significant neurobehavioral
comorbidities whose presentation overlapped with their
seizures and, hence, could benefit from the use of the electrocorticography data stored by the
neurostimulators. All saw improvements from changes in drug treatment, cognitive behavioural therapy or counseling to reduce symptoms such as panic-like attacks, psychosis and psychogenic nonepileptic seizures.
Dr Pa
ti, "The availability of ambulatory electrocorticography provides the opportunity to manage
comorbidities in
epilepsy that can mimic seizures and contribute to the overall poor quality of life."
Reference: Alexandra T. Issa Roach et al, Optimizing therapies for neurobehavioral comorbidities of epilepsy using chronic ambulatory electrocorticography, Epilepsy & Behavior (2019). DOI: 10.1016/j.yebeh.2019.106814
