Key result
Neurostimulation devices for drug resistant epilepsy produced electrophysiological artifacts in 37% of patients, which can mimic electrographic seizures or ECG abnormalities.
Why the study?
Neurostimulation devices are increasingly used for drug resistant epilepsy, making it important to recognize their artifacts in electrodiagnostic studies.
Observational (n=52)
No
Neurostimulation devices for drug-resistant epilepsy frequently produce EEG and ECG artifacts that can mimic seizures or cardiac arrhythmias.
Device artifacts may confound electrodiagnostic interpretation in DRE; leaves open prospective validation of recognition strategies.
Background: Neurostimulation devices including vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS) are approved therapeutic options for drug resistant epilepsy (DRE). As these devices are increasingly used in clinical practice, it is of importance to recognize their artifacts in electrodiagnostic studies. Methods: This is a retrospective study of all adult DRE patients treated with neuromodulation devices for epilepsy at our center between 2012 and 2021. Available EEGs were reviewed for neurostimulator-related artifacts. Results: Fifty-two patients were included. 37% of patients had neurostimulation related electrophysiological artifacts (20% of VNS, 75% of DBS, all patients with dual VNS-DBS treatment, and in the single patient with RNS). Artifacts were intermittent, appearing most commonly simultaenously in the EEG and ECG. VNS artifacts were monomorphic appearing mostly in the lower temporal EEG electrodes, whereas DBS artifacts were with variable morphology, amplitude, and scalp distribution. At times, the artifacts resembled electrographic seizures in the EEG and mimicked extrasystole or asystole in the ECG. Conclusions: With the increasing use of neurostimulation treatments for DRE, and the need for frequent electrodiagnostic studies in this patient population, it is important clinicians recognize these electrophysiological findings as artifacts, to avoid misdiagnosis and facilitate accurate interpretation.
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Arafat et al. (2022) conducted an observational in Drug resistant epilepsy (DRE) (n=52). Neurostimulation devices (VNS, DBS, RNS) was evaluated on Neurostimulation related electrophysiological artifacts. Neurostimulation devices for drug resistant epilepsy produced electrophysiological artifacts in 37% of patients, which can mimic electrographic seizures or ECG abnormalities.
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