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Stereoelectroencephalography in the setting of a previously implanted responsive neural stimulation device: illustrative case
Journal article   Open access

Stereoelectroencephalography in the setting of a previously implanted responsive neural stimulation device: illustrative case

Dorian M. Kusyk, Nicholas Blaney, Timothy Quezada and Alexander C. Whiting
Journal of neurosurgery. Case lessons, v 6(24), 23590
11 Dec 2023
DOI: https://doi.org/10.3171/CASE23590
PMID: 38079629
url
https://doi.org/10.3171/CASE23590View
Published, Version of Record (VoR) Open

Abstract

Clinical Neurology Life Sciences & Biomedicine Neurosciences & Neurology Science & Technology Surgery
BACKGROUND Responsive neural stimulation (RNS) is a relatively novel procedure for drug-resistant epilepsy, which involves implantation of a device into the skull and brain. As more devices are implanted, there may be an increasing need to perform intracranial electrocorticography in implant patients with persistent seizures. Given the device location, imaging difficulties with implanted devices, and other technical hurdles, stereoelectroencephalography (SEEG) could be especially challenging. The authors describe the first reported SEEG investigation in a patient with an RNS device, highlighting the technical challenges and clinical data ascertained. OBSERVATIONS A 41-year-old male with drug-resistant epilepsy presented several years after a local surgeon had placed an RNS device with two electrodes in the bilateral parieto-occipital lobes. Because of inadequate seizure control, the patient was offered a repeat SEEG investigation to characterize his epilepsy better. Although more technically challenging than a traditional SEEG implantation, the SEEG investigation was successfully performed, which led to a confirmation of bilateral hippocampal seizure onset. The patient underwent repositioning of his RNS leads with a significant decrease in his seizure frequency. LESSONS Concurrent implantation of SEEG electrodes in a functioning RNS device can be safely performed and can augment our understanding of a patient's seizures.

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