Responsive neurostimulation (RNS) for intractable epilepsy involves placement of electrodes onto or into the brain that detect seizure activity and then deliver a current to abort a seizure before it spreads. Successful RNS treatment can deliver hundreds of stimulations per day, which are generally unnoticeable to patients. Uncommonly, RNS electrodes may result in stimulation of brain regions or peripheral structures that causes uncomfortable sensory or motor effects, a phenomenon we refer to as stimulation-triggered signs or symptoms (STS). Occurrence of STS may limit the ability to use RNS to full capacity to reduce seizures. In this case series, we describe STS in six out of 58 (10.3%) RNS patients at our institution. To eliminate or minimize STS, we developed a protocol for modification of RNS parameters. Modifying RNS stimulation was associated with reduced STS in all six patients, five had adjustment of stimulation settings, one of lead position. Five out of six patients were able to undergo further optimization of RNS for improved seizure control after reduction of symptoms. One patient had recurrent STS that prevented further increase of RNS stimulation current. This study may help other medical teams in identifying and reducing STS in patients with epilepsy receiving RNS devices.

中文翻译：

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RNS 修改以消除刺激触发的体征或症状 (STS)：案例系列和实用指南

用于顽固性癫痫的响应性神经刺激 (RNS) 涉及将电极放置在大脑上或大脑中，以检测癫痫发作活动，然后在癫痫发作扩散之前提供电流以中止癫痫发作。成功的 RNS 治疗每天可以提供数百次刺激，而这些刺激通常不会被患者注意到。罕见的是，RNS 电极可能会刺激大脑区域或外围结构，从而导致不舒服的感觉或运动效果，我们将这种现象称为刺激触发的体征或症状 (STS)。STS 的发生可能会限制使用 RNS 来减少癫痫发作的能力。在本病例系列中，我们描述了我们机构 58 名 (10.3%) RNS 患者中的 6 名 STS。为了消除或最小化 STS，我们开发了一个修改 RNS 参数的协议。修改 RNS 刺激与所有 6 名患者的 STS 降低有关，其中 5 名调整了刺激设置，其中 1 名调整了引导位置。六分之五的患者能够在症状减轻后进一步优化 RNS 以改善癫痫发作控制。一名患者复发性 STS，阻止了 RNS 刺激电流的进一步增加。这项研究可能有助于其他医疗团队识别和减少接受 RNS 设备的癫痫患者的 STS。