Combined neurostimulation and epilepsy surgery associated with seizure reductions in multicenter study

A retrospective study in the Journal of Neurosurgery examined responsive neurostimulation (RNS) combined with resection or laser interstitial thermal therapy in 73 patients with drug-resistant epilepsy across nine centers. Patients had at least one year of follow-up, a mean age of 34 years, and a mean epilepsy duration of 21 years. The primary outcome was seizure reduction at one year; secondary outcomes included global clinical improvement and adverse events.

RNS was combined with resection in 92% of patients and laser ablation in 8.2%; 89% underwent both procedures on the same day. Reasons for combination treatment included eloquent cortex involvement and multifocal seizure onset. At one year, mean seizure reductions were 69% for focal impaired consciousness seizures and 67% for focal to bilateral tonic-clonic seizures. Overall, 48% experienced at least six months of seizure freedom, while four patients had no seizures after surgery. Much or very much improved global clinical status was reported in 79%.

Three patients developed infections. One patient died from sudden unexpected death in epilepsy, reported as unrelated to surgical treatment. These findings support further investigation in complex surgical candidates, but the retrospective design and absence of a reported comparator prevent determining the added benefit of combining treatments.