Devices in Lennox-Gastaut Syndrome
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Anup Patel, MD, discusses devices for Lennox-Gastaut Syndrome
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Devices in Lennox-Gastaut Syndrome
- 2. ………………..…………………………………………………………………………………………………………………………………….. Anup Patel, MD • Section Chief Neurology at Nationwide Children’s Hospital • Associate Professor at the Ohio State University College of Medicine • Director Complex Epilepsy Clinic • Chair Professional Advisory Board Lennox Gastaut Syndrome Foundation
- 3. ………………..…………………………………………………………………………………………………………………………………….. Definition of Lennox Gastaut (LGS) • Multiple seizure types, to include tonic, atonic, and atypical absence seizures, with tonic seizures predominantly occurring at night • Abnormal EEG, consisting primarily of an interictal pattern of diffuse, slow spike-wave (SSW) complexes at <3Hz, occurring during wakefulness • Additional features, required as diagnostic by many, include paroxysmal fast rhythms (10–20 Hz) during sleep • Developmental delay or regression
- 4. ………………..…………………………………………………………………………………………………………………………………….. Vagus Nerve Stimulation • Not invasive brain surgery • FDA approved for 4 years and older • Evidence for LGS exists • Newer models: • 106 (Aspire SR) – heart rate detection and autostimulation • 1000 (Sentiva) – smaller device with motion sensation and heart rate
- 6. ………………..…………………………………………………………………………………………………………………………………….. Deep Brain Stimulation • Invasive brain surgery with generator outside brain • Used originally for Parkinson disease • Studies performed in epilepsy • FDA approval did not occur originally • Ongoing second evaluation • Electrodes placed deep into brain with stimulation
- 8. ………………..…………………………………………………………………………………………………………………………………….. Connection of Brain Pathways • Suggest that the mediodorsal and ventrolateral thalamus may be the main pathways of seizures for LGS patients • May be targets for changing the abnormal network in LGS • Potential for treatment using thalamic neurostimulation therapies like deep brain stimulation (DBS)
- 9. ………………..…………………………………………………………………………………………………………………………………….. Responsive Neurostimulation • Invasive brain surgery with generator under skull • FDA approved for patients 18 years and older • Compassionate use available for patients 8 years and older • Approved for partial seizures that come from one or two seizure targets identified
- 11. ………………..…………………………………………………………………………………………………………………………………….. Evidence for Devices • 50% of patients respond to Vagus nerve stimulation (VNS) therapy with a > 50% reduction in seizures, and the response may improve over time • 2014 AAN Guideline Paper states that VNS should be considered • No evidence exists for responsive neurostimulation (RNS) by NeuroPace • Limited evidence exists for deep brain stimulation (DBS) by Medtronic • 4 patients Lennox-Gastaut syndrome showed >50% reduction in seizure frequency
- 13. ………………..…………………………………………………………………………………………………………………………………….. Seizure Detection Devices • Smartwatch • Emfit • Embrace • Pebble • Fitbit • Apple Watch • Korwave • Brain Sentinel
- 24. ………………..…………………………………………………………………………………………………………………………………….. Research and Care Kit • Apple App: • https://www.apple.com/researchkit/ • Research Kit: Purpose to use for medical research • Care Kit • Track care plans • Monitor progress • Share insights with care teams
- 25. ………………..…………………………………………………………………………………………………………………………………….. EpiWatch App • Developed through Research Kit • Data collected by Johns Hopkins for people with epilepsy wearing an Apple Watch • Determine stress was a trigger for seizures
- 26. ………………..…………………………………………………………………………………………………………………………………….. Track it App for Apple Watch • Track it is a seizure diary app (iOS and Android) to record seizures and data about seizures • Developed by Rob and Lisa Moss • Working on data input into EPIC • Nationwide Children’s Hospital built the Apple Watch App for them • Now can input data about seizures from the Apple Watch
- 27. ………………..…………………………………………………………………………………………………………………………………….. Summary • Limited information on devices present • More work needed in LGS patients • Better seizure detection devices needed for LGS patients • Need to develop seizure prediction devices or software • Good seizure diaries exist with phone and watch apps