Search

Objectives To evaluate the efficacy of intracranial stimulation to treat refractory epilepsy in children. Methods This is a retrospective analysis of a pilot study on all 8 children who had intracranial electrical stimulation for the investigation and treatment of refractory epilepsy at King's College Hospital between 2014 and 2015. Five children (one with temporal lobe epilepsy and four with frontal lobe epilepsy) had subacute cortical stimulation (SCS) for a period of 20–161 h during intracranial video-telemetry. Efficacy of stimulation was evaluated by counting interictal discharges and seizures. Two children had thalamic deep brain stimulation (DBS) of the centromedian nucleus (one with idiopathic generalized epilepsy, one with presumed symptomatic generalized epilepsy), and one child on the anterior nucleus (right fronto-temporal epilepsy). The incidence of interictal discharges was evaluated visually and quantified automatically. Results Among the three children with DBS, two had >60% improvement in seizure frequency and severity and one had no improvement. Among the five children with SCS, four showed improvement in seizure frequency (>50%) and one chid did not show improvement. Procedures were well tolerated by children. Conclusion Cortical and thalamic stimulation appear to be effective and well tolerated in children with refractory epilepsy. SCS can be used to identify the focus and predict the effects of resective surgery or chronic cortical stimulation. Further larger studies are necessary. [ABSTRACT FROM AUTHOR]

Objective Patients' expectations are considered to play an important role in subthalamic nucleus (STN) deep brain stimulation (DBS). We explored the relationship among expectations, satisfaction, and outcome 6 years after surgery. Methods Fifteen patients with Parkinson disease (9 males, mean age 60.5 ± 6.4 years) undergoing STN DBS completed a modified PDQ-39 questionnaire (incorporating an assessment of patients' expected changes in addition to the standard quality of life items) preoperatively and at 6 years postoperatively. A satisfaction questionnaire accompanied the postoperative questionnaire. Results At 6 years' follow-up, PDQ-39 scores were unchanged from preoperative scores except in the stigma domain, which showed significant improvement. There was no significant difference between the postoperatively rated expected PDQ-39 summary score and the postoperative actual PDQ-39 summary score. However, there was a significant difference between the preoperatively rated expected PDQ-39 summary score and the postoperative actual PDQ-39 summary score. Patients remained highly satisfied with the outcome of surgery (mean satisfaction score 83%). Satisfaction did not correlate with PDQ-39 summary scores, domain scores, or fulfilment of expectations. The more satisfied patients (satisfaction ≥80%) changed their expectations so that their postoperatively rated expectations reflected a less favorable condition, whereas no such change was seen in the less satisfied (satisfaction <80%) patients. Conclusions Patients remain highly satisfied with STN DBS 6 years after surgery, although quality of life assessed by the PDQ-39 may return to baseline levels. Patients' expectations change over time and may influence patient satisfaction. Managing expectations before and after surgery plays an essential role in STN DBS. Highlights • Patients remain highly satisfied with STN DBS 6 years after surgery. • Patients' expectations change over time and may influence patient satisfaction. • Managing expectations before and after surgery plays an essential role in STN DBS. [ABSTRACT FROM AUTHOR]