Focal Cortex Stimulation With a Novel Implantable Device and Antiseizure Outcomes in 2 Prospective Multicenter Single-Arm Trials

Author:

Schulze-Bonhage Andreas1234,Hirsch Martin1,Knake Susanne5,Kaufmann Elisabeth6,Kegele Josua7,Rademacher Michael8,Vonck Kristl9,Coenen Volker Arnd101112,Glaser Martin13,Jenkner Carolin1415,Winter Yaroslav515,Groppa Sergiu16,Borger Valerie17,Dewaele Frank17,Kunz Mathias17,Naros Georgios17,Nimsky Christopher17,

Affiliation:

1. Epilepsy Center, Neurocenter, University Medical Center, University of Freiburg, Freiburg, Germany

2. NeuroModul Basic, University of Freiburg, Freiburg, Germany

3. Bernstein Center of Computational Neuroscience, University of Freiburg, Freiburg, Germany

4. European Reference Network EpiCare

5. Neurology, University Hospital Marburg, Marburg, Germany

6. Department of Neurology, University Hospital, Ludwig-Maximilan’s University, Munich, Germany

7. Hertie Institute for Clinical Brain Research, Department of Neurology and Epileptology, University of Tübingen, Tübingen, Germany

8. Epileptology, University Hospital Bonn, Bonn, Germany

9. Neurology, University Hospital Ghent, Ghent, Belgium

10. Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg, Germany

11. Medical Faculty of the University of Freiburg, Frieburg im Breisgau, Germany

12. Center for Deep Brain Stimulation, Medical Center of the University of Freiburg, Freiburg, Germany

13. Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany

14. Study Center, University Medical Center, University of Freiburg, Freiburg, Germany

15. Mainz Comprehensive Epilepsy and Sleep Medicine Center, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

16. Neurology, University Hospital Mainz, Mainz, Germany

17. for the EASEE Study Group

Abstract

ImportanceFor the large population of people with drug-refractory epilepsy, alternative treatment approaches are needed. Clinical trial outcomes of a novel stimulation device, which is newly available in Europe for the treatment of patients with a predominant seizure focus, are reported for the first time.ObjectiveTo perform a pooled analysis of the results of 2 prospective, multicenter, single-arm trials, A Pilot Study to Assess the Feasibility of Neurostimulation With the EASEE System to Treat Medically Refractory Focal Epilepsy (EASEE II) and A Pilot Study to Assess the Feasibility of Patient-Controlled Neurostimulation With the EASEE System to Treat Medically Refractory Focal Epilepsy (PIMIDES I), assessing the safety and efficacy of epicranial focal cortex stimulation (FCS) with a novel implantable device (EASEE [Precisis]) as adjunctive treatment for adult patients with drug-refractory focal epilepsy.Design, Setting, and ParticipantsThis study was a pooled analysis of 2 nonrandomized uncontrolled trials, EASEE II and PIMIDES I, which began on January 15, 2019, and January 14, 2020, respectively, and ended on July 28, 2021. EASEE II and PIMIDES I were the first in-human, prospective, single-arm trials with an 8-month evaluation period. Patients were recruited at 7 European epilepsy centers. Consecutive participants with drug-refractory focal epilepsy were enrolled. Study data were analyzed from September 29, 2021, to February 2, 2022.InterventionsAfter a 1-month prospective baseline period, patients were implanted with the neurostimulation device. After a 1-month postimplantation recovery period, unblinded FCS was activated using both high-frequency and direct current (DC)–like components performed via electrode arrays placed epicranially above the individual epileptic focus region.Main Outcomes and MeasuresEfficacy was prospectively assessed by the responder rate in the sixth month of stimulation compared with baseline; safety and additional end points were assessed after device implantation and during the stimulation period.ResultsOf the 34 adult patients enrolled at 6 German and 1 Belgian investigational site, 33 (mean [SD] age, 34.6 [13.5] years; 18 male patients [54.5%]) received the neurostimulation device implant. A total of 32 patients underwent combined high-frequency direct current–like stimulation at least until the 8-month postimplant follow-up visit. After 6 months of stimulation, 17 of 32 patients (53.1%) were responders to treatment with at least a 50% reduction in seizure frequency compared with baseline, corresponding to a significant median seizure reduction by 52% (95% CI, 0.37%-0.76%; P < .001). No device- or procedure-related serious adverse events were reported (0; 95% CI, 0%-10.58%). There were no significant alterations in cognition, mood, or overall quality of life.Conclusions and RelevanceResults of this pooled analysis of 2 nonrandomized uncontrolled trials suggest that FCS with a novel neurostimulation device was associated with an effective reduction in seizure frequency in patients with drug-refractory focal epilepsy and may offer a promising treatment option for patients with a predominant epileptic focus.Trial RegistrationGerman Clinical Trials Register: DRKS00015918 and DRKS00017833, respectively, and jointly under PROSPERO: CRD42021266440

Publisher

American Medical Association (AMA)

Subject

Neurology (clinical)

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