Responsive stimulation of motor cortex for medically and surgically refractive epilepsy

Epilepsy is a complex disease that evolves throughout patients’ lives. For many, seizure management requires escalation from single-drug therapy to multi-drug therapy, adjuvant placement of a vagal nerve stimulation (VNS), and ultimately surgical resection or laser-ablation of the epileptic focus [1]. However, if the seizure focus lies within a region of movement or speech eloquence, lesioning or resection may not be possible without causing neurological deficit. Prior resection may create scarring that prohibits subdural electrode placement. We describe placement of an intracortical responsive neurostimulator (RNS) [2] in motor cortex of a patient whose seizures were refractory to multiple concurrent anti-epileptic drugs, VNS, and prior partial seizure focus resection.