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The Terminal Man—from Science Fiction to Therapy

Automated Seizure Abatement in Humans Using Electrical Stimulation Osorio I, Frei MG, Sunderam S, Giftakis J, Bhavaraju NC, Schaffner SF, Wilkinson SB Ann Neurol 2005;57:258–268 The need for novel, efficacious, antiseizure therapies is widely acknowledged. This study investigates in humans the feasibility, safety, and efficacy of high-frequency electrical stimulation (HFES; 100–500 Hz) triggered by automated seizure detections. Eight patients were enrolled in this study, which consisted of a control and an experimental phase. HFES was delivered directly to the epileptogenic zone (local closed-loop) in four patients and indirectly, through anterior thalami (remote closed-loop), to the other four patients for every other automated seizure detection made by a validated algorithm. Interphase (control vs. experimental phase) and intraphase (stimulated vs. nonstimulated) comparisons of clinical seizure rate and relative severity (clinical and electrographic) were performed, and differences were assessed by using effect size. Patients were deemed “responders” if seizure rate was reduced by at least 50%; the remaining patients were deemed “nonresponders.” All patients completed the study; rescue medications were not required; 1,491 HFESs (0.2% triggered afterdischarges) were included. Mean change in seizure rate in the local closed-loop group was −55.5% (–100 to +36.8%); three of four responders had a mean change of −86% (–100 to −58.8%). In the remote closed-loop, the mean change of seizure rate was −40.8% (–72.9 to +1.4%); two of four responders had a mean change of −74.3% (–75.6 to −72.9%). Mean effect size was zero in the local closed-loop (responders: beneficial and medium to large in magnitude) and negligible in the remote closed-loop group (responders: beneficial and medium to large). HFES effects on epileptogenic tissue were immediate and also outlasted the stimulation period. This study demonstrates the feasibility and short-term safety of automated HFES for seizure blockage and also raises the possibility that it may be beneficial in pharmacoresistant epilepsies.