RNS vs Surgery among Patients with Epilepsy in Eloquent Foci

Introduction: Epilepsy is a significant cause of morbidity and mortality throughout the world, and nearly half of patients suffering from epilepsy are unresponsive to medical management. Patients with epilepsy refractory to medical management have historically been offered surgical resection of the location of their brain responsible for seizures. While this method has proven effective in eliminating seizures, some patients with epilepsy foci located in eloquent cortices are at high risk of losing critical human functions as a result of surgery including loss of language and motion. Neuropace Responsive Neurostimulation (RNS) is an implant that detects and responds to seizure activity and may be a safer alternative to surgical resection among patients with refractory epilepsy who have foci in areas of eloquent cortices. The clinical question addressed herein is thus: (P) among patients with refractory epilepsy with seizures involving eloquent cortices, (I) is NMS (O) or (C) surgical resection (O) safer and more effective in reducing seizures. Methods: A literature search of Google Scholar, PubMed, and EbscoHost was performed in September 2018. The search revealed seven articles that met inclusion criteria which ranged from randomized controlled trials to case studies. The seven articles were compared in their study design, analysis, and outcomes. Results: To date, no study has directly compared surgical resection to Neuropace RNS in safety and efficacy of seizure reduction among patients with refractory epilepsy. In separate randomized controlled trials, Neuropace RNS and Surgical resection both significantly reduced seizures among patients with refractory epilepsy. There was a higher rate of adverse events in the study evaluating surgical resection vs medical management compared to the study evaluating Neuropace vs medical management. There was also a higher rate of elimination of seizure activity within the study looking at surgical resection compared to that investigating Neuropace. Quality of life significantly improved with both interventions. Discussion: Surgical resection and Neuropace RNS both significantly reduce seizure activity and improved quality of life when compared to medical management. A direct comparison between the two interventions has never been performed. Surgical intervention is a high-risk high reward intervention, while Neuropace is a less risky, and likely less effective intervention. Conclusion: Neuropace RNS is a novel device that can be implanted into patients with epilepsy to detect and respond to seizures refractory to medical management. Surgical resection of seizure foci also reduces seizure activity but is irreversible. Enough evidence exists to reveal the favorability of Neuropace RNS over surgical resection among patients with epileptic foci localized to areas of eloquent cortices. Future research should compare the safety and efficacy of Neuropace to that of surgical resection in a diverse population