Responsive Neuro-Stimulation (Neuropace, RNS) Werner Doyle, MD Professor of Neurosurgery April 27, 2014

Epilepsy / Seizure normal is unpredictable in the temporal and spacial domains Sz is predicatbale and similar changes in space and time

desynchronized “chaotic” normal hyper-synchrony “rhythmic” seizure

Seizure is a loss of brain processing complexity complicated simple

he hypothesis: chaotic is not random but complex he hypothesis: chaotic is not random but complex. . . so complexity is a characteristic of a healthy nervous system

genersist to fundamentals - very reductionist Jellyfish 800 Lobster 100,000 Ant 250,000 Honey bee 960,000 Cockroach 1,000,000 Octopus 300,000,000 Cat 1,000,000,000 Chimpanzee 6,700,000,000 Elephant 23,000,000,000

302 (hermaphrodyte) or 353 neurons (male)

probabilistic tractography, cortical thickness correlations, connectivity

The brain is a complex dynamic network

ablative VNS RNS

Surgical Removal or Disconnection

VNS - Vagus Nerve Stimulation

RNS - Responsive Neuro-Stimulaiton

↯ ✘ 2-Stage 1-Stage

Cranial Epilepsy Surgery Cranial surgery: 1 or 2 operations & hospitalized for 3 to 10 days. Complete seizure control in 90% of the best surgery candidates & at least 50% of the time for the more difficult patients. 65% of all epilepsy surgery patients at NYU are seizure free

RNS (Responsive Neuro-Stimulation) RNS surgery: usually in the hospital for 3 to 4 days Complete seizure control in 20% & at least 50% control for the most difficult patients Offered to those that we can not do resection safely

Best candidates for epilepsy surgery: MRI abnormalities such as hippocampus scar, low grade tumor, developmental abnormality, and some vascular lesions hippocampus scar vascular lesion cavernoma developmental cortical dysplasia low grade tumor

The Comprehensive Epilepsy Center at NYU Langone Medical Center is one of the largest of centers devoted to the treatment of epilepsy and related conditions in the United States. For additional information about epilepsy surgery or for an appointment, or to speak with an epilepsy surgery specialist, call 646 558 0804 or 646 558 0800. All medical insurance is accepted and if authorization has not been obtained a consultation with Dr. Doyle will be possible without fee. Arrangements will be made for any patient to be seen for an initial surgical consultation with or without the ability to pay.

Epilepsy Surgery Team Werner Doyle, MD (Neurosurgeon) Alyson Silverberg, DNP, RN, NP Mary Miceli, DNP, RN, NP 223 E 34th Street New York, NY 10016 646 558 0804