Skip to main content
AAN.com
Articles
September 14, 2011

Responsive cortical stimulation for the treatment of medically intractable partial epilepsy

Martha J. Morrell, MD On behalf of the RNS System in Epilepsy Study GroupAuthors Info & Affiliations
September 27, 2011 issue
77 (13) 1295-1304

Abstract

Objectives:

This multicenter, double-blind, randomized controlled trial assessed the safety and effectiveness of responsive cortical stimulation as an adjunctive therapy for partial onset seizures in adults with medically refractory epilepsy.

Methods:

A total of 191 adults with medically intractable partial epilepsy were implanted with a responsive neurostimulator connected to depth or subdural leads placed at 1 or 2 predetermined seizure foci. The neurostimulator was programmed to detect abnormal electrocorticographic activity. One month after implantation, subjects were randomized 1:1 to receive stimulation in response to detections (treatment) or to receive no stimulation (sham). Efficacy and safety were assessed over a 12-week blinded period and a subsequent 84-week open-label period during which all subjects received responsive stimulation.

Results:

Seizures were significantly reduced in the treatment (−37.9%, n = 97) compared to the sham group (−17.3%, n = 94; p = 0.012) during the blinded period and there was no difference between the treatment and sham groups in adverse events. During the open-label period, the seizure reduction was sustained in the treatment group and seizures were significantly reduced in the sham group when stimulation began. There were significant improvements in overall quality of life (p < 0.02) and no deterioration in mood or neuropsychological function.

Conclusions:

Responsive cortical stimulation reduces the frequency of disabling partial seizures, is associated with improvements in quality of life, and is well-tolerated with no mood or cognitive effects. Responsive stimulation may provide another adjunctive treatment option for adults with medically intractable partial seizures.

Classification of evidence:

This study provides Class I evidence that responsive cortical stimulation is effective in significantly reducing seizure frequency for 12 weeks in adults who have failed 2 or more antiepileptic medication trials, 3 or more seizures per month, and 1 or 2 seizure foci.

Get full access to this article

View all available purchase options and get full access to this article.

COINVESTIGATORS

David King-Stephens, MD (California Pacific Medical Center, Site Principal Investigator and manuscript review), Andrew D. Massey, MD (Via Christi Comprehensive Epilepsy Center, Site Principal Investigator), Christianne N. Heck, MD (University of Southern California, Site Principal Investigator), Dileep R. Nair, MD (The Cleveland Clinic Foundation, Site Principal Investigator), Gregory L. Barkley, MD (Henry Ford Hospital, Site Principal Investigator), Andrew J. Cole, MD (Massachusetts General Hospital, Site Principal Investigator), Ryder P. Gwinn, MD (Swedish Medical Center, Site Principal Investigator), Barbara C. Jobst, MD (Dartmouth-Hitchcock Medical Center, Site Principal Investigator), Vicenta Salanova, MD (Indiana University, Site Principal Investigator), Christopher T. Skidmore, MD (Thomas Jefferson University, Site Principal Investigator), Michael C. Smith, MD (Rush Medical Center, Site Principal Investigator), Paul C. Van Ness, MD (University of Texas Medical Center, Site Principal Investigator), Gregory K. Bergey, MD (Johns Hopkins University School of Medicine, Site Principal Investigator), Michael Duchowny, MD (Miami Children's Hospital, Site Principal Investigator), Eric B. Geller, MD (Saint Barnabas Medical Center, Site Principal Investigator), Yong D. Park, MD (Medical College of Georgia, Site Principal Investigator), Paul A. Rutecki, MD (University of Wisconsin Hospital and Clinics, Site Principal Investigator), David C. Spencer, MD (Oregon Health & Science University, Site Principal Investigator), Richard Zimmerman, MD (Mayo Clinic Arizona, Site Principal Investigator), Jonathan C. Edwards, MD (Medical College of South Carolina, Site Principal Investigator), Eli Mizrahi, MD (Baylor College of Medicine, Site Principal Investigator), Michel J. Berg, MD (University of Rochester, Site Principal Investigator), A. James Fessler III, MD (University of Rochester, Site Principal Investigator), Nathan B. Fountain, MD (University of Virginia, Site Principal Investigator), James W. Leiphart, MD, PhD (George Washington University, Site Principal Investigator), Robert E. Wharen, Jr., MD (Mayo Clinic Florida, Site Principal Investigator), Lawrence J. Hirsch, MD (Columbia University Medical Center, Site Principal Investigator), W. Richard Marsh, MD (Mayo Clinic Rochester, Site Principal Investigator), Robert E. Gross, MD, PhD (Emory University, Site Principal Investigator), Robert B. Duckrow, MD (Yale University School of Medicine, Site Principal Investigator), Stephan Eisenschenk, MD (University of Florida, Gainesville, Site Principal Investigator), Cormac A. O'Donovan, MD (Wake Forest University Health Sciences, Site Principal Investigator). Daniel A. Bloch, PhD (NeuroPace, Consulting Biostatistician), Tami Crabtree (NeuroPace, Consulting Biostatistician), David Loring, PhD (Emory University, Consulting Neuropsychologist), Audra Plenys Loftman, PhD (NeuroPace, data analysis and manuscript preparation), Felice T. Sun, PhD (NeuroPace, data analysis and manuscript preparation), Martha J. Morrell, MD (NeuroPace, study design, analysis and primary manuscript preparation).

REFERENCES

1.
Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000;342:314–319.
2.
Schuurman PR, Bosch DA, Bossuyt PM, et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med 2000;342:461–468.
3.
Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia 2010;51:899–908.
4.
Vickrey BG, Perrine KR, Hays RD, et al. Quality of Life in Epilepsy QOLIE-89 (version 1.0): Scoring Manual and Patient Inventory. Santa Monica: RAND; 1993.
5.
Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory–II. San Antonio, TX: Psychological Corporation; 1996.
6.
Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385–401.
7.
James KE, Bloch DA, Lee KK, Kraemer HC, Fuller RK. An index for assessing blindness in a multi-centre clinical trial: disulfiram for alcohol cessation: a VA cooperative study. Stat Med 1996;15:1421–1434.
8.
Tanriverdi T, Ajlan A, Poulin N, Olivier A. Morbidity in epilepsy surgery: an experience based on 2449 epilepsy surgery procedures from a single institution. J Neurosurg 2009;110:1111–1123.
9.
Wong CH, Birkett J, Byth K, et al. Risk factors for complications during intracranial electrode recording in presurgical evaluation of drug resistant partial epilepsy. Acta Neurochir 2009;151:37–50.
10.
Fountas KN, Smith JR. Subdural electrode-associated complications: a 20-year experience. Stereotact Funct Neurosurg 2007;85:264–272.
11.
Hamer HM, Morris HH, Mascha EJ, et al. Complications of invasive video-EEG monitoring with subdural grid electrodes. Neurology 2002;58:97–103.
12.
Behrens E, Schramm J, Zentner J, Konig R. Surgical and neurological complications in a series of 708 epilepsy surgery procedures. Neurosurgery 1997;41:1–9.
13.
Oh MY, Abosch A, Kim SH, Lang AE, Lozano AM. Long-term hardware-related complications of deep brain stimulation. Neurosurgery 2002;50:1268–1276.
14.
Beric A, Kelly PJ, Rezai A, et al. Complications of deep brain stimulation surgery. Stereotact Funct Neurosurg 2001;77:73–78.
15.
Hariz MI. Complications of deep brain stimulation surgery. Mov Disord 2002;17(suppl 3):S162–S166.
16.
Joint C, Nandi D, Parkin S, Gregory R, Aziz T. Hardware-related problems of deep brain stimulation. Mov Disord 2002;17(suppl 3):S175–S180.
17.
Koller WC, Lyons KE, Wilkinson SB, et al. Long-term safety and efficacy of unilateral deep brain stimulation of the thalamus in essential tremor. Mov Disord 2001;16:464–468.
18.
Hodaie M, Wennberg RA, Dostrovsky JO, Lozano AM. Chronic anterior thalamus stimulation for intractable epilepsy. Epilepsia 2002;43:603–608.
19.
Lesser RP. Remission of intractable partial epilepsy following implantation of intracranial electrodes. Neurology 2002;58:1317.
20.
Katariwala NM, Bakay RA, Pennell PB, et al. Remission of intractable partial epilepsy following implantation of intracranial electrodes. Neurology 2001;57:1505–1507.
21.
Hessen E, Lossius MI, Gjerstad L. Health concerns predicts poor quality of life in well-controlled epilepsy. Seizure 2009;18:487–491.
22.
Loring DW, Meador KJ, Lee GP. Determinants of quality of life in epilepsy. Epilepsy Behav 2004;5:976–980.
23.
Jacoby A, Snape D, Baker GA. Determinants of quality of life in people with epilepsy. Neurol Clin 2009;27:843–863.
24.
Markand ON, Salanova V, Whelihan E, Emsley CL. Health-related quality of life outcome in medically refractory epilepsy treated with anterior temporal lobectomy. Epilepsia 2000;41:749–759.
25.
Lee WS, Lee JK, Lee SA, et al. Complications and results of subdural grid electrode implantation in epilepsy surgery. Surg Neurol 2000;54:346–351.
26.
Wiggins GC, Elisevich K, Smith BJ. Morbidity and infection in combined subdural grid and strip electrode investigation for intractable epilepsy. Epilepsy Res 1999;37:73–80.
27.
Pahwa R, Factor SA, Lyons KE, et al. Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006;66:983–995.
28.
Engel J, Wiebe S, French J, et al. Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology 2003;60:538–547.
29.
Perucca P, Carter J, Vahle V, Gilliam FG. Adverse antiepileptic drug effects: toward a clinically and neurobiologically relevant taxonomy. Neurology 2009;72:1223–1229.
30.
French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2004;62:1261–1273.
31.
Kimiskidis VK, Triantafyllou NI, Kararizou E, et al. Depression and anxiety in epilepsy: the association with demographic and seizure-related variables. Ann Gen Psychiatry 2007;6:28.
32.
O'Donoghue MF, Goodridge DM, Redhead K, et al. Assessing the psychosocial consequences of epilepsy: a community-based study. Br J Gen Pract 1999;49:211–214.
33.
Jacoby A, Baker GA, Steen N, Potts P, Chadwick DW. The clinical course of epilepsy and its psychosocial correlates: findings from a UK community study. Epilepsia 1996;37:148–161.
34.
Manchanda R, Schaefer B, McLachlan RS, et al. Psychiatric disorders in candidates for surgery for epilepsy. J Neurol Neurosurg Psychiatry 1996;61:82–89.
35.
Tellez-Zenteno JF, Patten SB, Jette N, et al. Psychiatric comorbidity in epilepsy: a population-based analysis. Epilepsia 2007;48:2336–2344.
36.
Bell GS, Gaitatzis A, Bell CL, et al. Suicide in people with epilepsy: how great is the risk? Epilepsia 2009;50:1933–1942.
37.
Pompili M, Girardi P, Tatarelli R. Death from suicide versus mortality from epilepsy in the epilepsies: a meta-analysis. Epilepsy Behav 2006;9:641–648.
38.
Rafnsson V, Olafsson E, Hauser WA, Gudmundsson G. Cause-specific mortality in adults with unprovoked seizures: a population-based incidence cohort study. Neuroepidemiology 2001;20:232–236.
39.
Thompson PJ, Duncan JS. Cognitive decline in severe intractable epilepsy. Epilepsia 2005;46:1780–1787.
40.
Dasheiff RM. Sudden unexpected death in epilepsy: a series from an epilepsy surgery program and speculation on the relationship to sudden cardiac death. J Clin Neurophysiol 1991;8:216–222.

Information & Authors

Information

Published In

Neurology®
Volume 77Number 13September 27, 2011
Pages: 1295-1304
PubMed: 21917777

Publication History

Received: February 2, 2011
Accepted: May 24, 2011
Published online: September 14, 2011
Published in print: September 27, 2011

Permissions

Request permissions for this article.

Disclosure

Dr. Morrell is an employee of and holds stock options in NeuroPace, Inc.; is an employee of Stanford University in epilepsy clinical practice (20% effort); has received speaker honoraria from GlaxoSmithKline; serves on the editorial board of Neurostimulation; is on the nominating committee of the American Society of Experimental Neurotherapeutics (ASENT); and is on the Board of Directors of the Epilepsy Research Foundation.

Authors

Affiliations & Disclosures

Martha J. Morrell, MD On behalf of the RNS System in Epilepsy Study Group
From NeuroPace, Inc., Mountain View, CA.

Notes

Study funding: Sponsored by NeuroPace, Inc., which participated in acquisition of data, statistical analysis, study supervision, and approval of data.
Address correspondence and reprint requests to Dr. Martha J. Morrell, NeuroPace, Inc., 1375 Shorebird Way, Mountain View, CA 94043 [email protected]

Contributors

California Pacific Medical Center: Kenneth D. Laxer, MD, Peter B. Weber, MD; Coordinators: R. Douglas Raggett, RN, Angie Stone. Via Christi Comprehensive Epilepsy Center: Kore Liow, MD, Nazih Moufarrij, MD; Coordinators: Toni Sadler, PA-C, Ginger Otipoby, Ann Brenner, N. Keith Trevolt, ARNP. University of Southern California: Rami G. Apelian, MD, Vidya Hawkins, DO, Neda Heidari, MD, Laura A. Kalayjian, MD, Reed L. Levine, MD, Charles Y. Liu, MD, PhD, Andrew D. Ly, MD, Johnson L. Moon, MD, Jason S. Muir, MD, Ron A. Shatzmiller, MD, MS, Parastou Shilian, MD, Steve N. Sykes, MD; Coordinators: Sandra Oviedo, Guadalupe Levya-Corral. The Cleveland Clinic Foundation: Andreas V. Alexopoulos, MD, MPH, William E. Bingaman, MD, Lara Jehi, MD, Prakash Kotagal, MD, Imad Michael Naijm, MD; Coordinators: Deborah Johnston, Jennifer Turczyk. Henry Ford Hospital: Konstantin V. Elisevich, MD, PhD, Shailaja Gaddam, MD, Madhuri L. Koganti, MD, Amit Ray, MD, Brien J. Smith, MD, Andrea F. Sneider, DO, Marianna Spanaki-Varelas, MD, PhD, Vibhangini S. Wasade, MD; Coordinator: Helen Foley, RN. Massachusetts General Hospital: Sydney S. Cash, MD, PhD, Emad N. Eskandar, MD, Daniel B. Hoch, MD, PhD; Coordinators: Justine Cormier, Tara Jennings NP, Kate Kovach. Swedish Medical Center: Lisa M. Caylor, MD, Michael J. Doherty, MD, John D. Morgan, MD, David G. Vossler, MD; Coordinators: Caryl Tongco, Amanda Brown. Dartmouth-Hitchcock Medical Center: Krzysztof A. Bujarski, MD, Ann-Christine Duhaime, MD, Gregory L. Holmes, MD, Erik Kobylarz, MD, PhD, Richard P. Morse, MD, David W. Roberts, MD, Vijay M. Thadani, MD, PhD; Coordinators: Emily Clough, Shirley Eaton, Faith Alexandre, Karen Gilbert, NP-C, CNRN; Karen Richardson, RN. Indiana University: Andrew J. Kalnin, MD, Omkar N. Markand, MD, Dragos Sabau, MD, Thomas C. Witt, MD, Robert M. Worth, MD, PhD; Coordinators: Marsha Manley, RN, Linda Perdue. Thomas Jefferson University: James J. Evans, MD, Scott E. Mintzer, MD, Maromi Nei, MD, Ashwini D. Sharan, MD, Michael R. Sperling, MD, Andre Zangaladze, MD, PhD; Coordinators: Leigh Stott, Mary Kate Burke. Rush Medical Center: Donna C. Bergen, MD; Richard W. Byrne, MD; Marvin A. Rossi, MD, PhD; Coordinators: Debora Zielinski, RN, Carol Macpherson. University of Texas Medical Center: Mark A. Agostini, MD, Sachin Dave, MD, Ramon Diaz-Arrastia, MD, PhD, Puneet K. Gupta, MD, MSE, Christopher J. Madden, MD, Pradeep N. Modur, MD, MS, Louis Anthony Whitworth, MD; Coordinators: Mary Beth Basham, LVN, Dinah Turner-Knight, RN. Johns Hopkins University School of Medicine: George I. Jallo, MD, Eric H.W. Kossoff, MD, Frederick A. Lenz, MD, PhD, Eva Katharina Ritzl, MD; Coordinators: Pam Coe, Joanne Barnett. Miami Children's Hospital: Sanjiv Bhatia, MD, Prasanna Jayakar, MD, PhD, Ian Miller, MD, Glen Morrison, MD, John Ragheb, MD, Trevor J. Resnick, MD; Coordinator: Ricardo Luzondo, MD. Saint Barnabas Medical Center: Orrin Devinsky, MD, Werner Doyle, MD, Mangala A. Nadkarni, MD, Peter P. Widdess-Walsh, BA, MB, BCh, BAO, MRCPI; Coordinator: Emilie Jade Misajon, RN. Medical College of Georgia: Cole A. Giller, MD, PhD, MBA, Ki-Hyeong Lee, MD, MS, Mark R. Lee, MD, PhD, Anthony M. Murro, MD, Jeffrey M. Politsky, MD, Joseph R. Smith, MD, Suzanne M. Strickland, MD, Jeffrey A. Switzer, DO; Coordinator: Patty Ray, PhD. University of Wisconsin Hospital and Clinics: Mustafa K. Baskaya, MD, Brad R. Beinlich, MD, Rahul Dewan, MD, Victor Diaz-Cotrina, MD, John C. Jones, MD, Lincoln F. Ramirez, MD, PhD, Edgar A. Samaniego, MD, MS, Raj D. Sheth, MD, Karl A. Sillay, MD, Evelyn C. Tunnell, MD; Coordinators: Talley Mitchell, Andrea Maser. Oregon Health & Science University: James J. Cereghino, MS, MD, Felicia A. Ferguson, MD, Mary M. Ransom, MD, Martin C. Salinsky, MS, MD, William Brewster Smith, MD; Coordinator: Rebecca Hoffenberg. Mayo Clinic Arizona: Joseph F. Drazkowski, MD, Katherine H. Noe, MD, PhD, Joseph I. Sirven, MD; Coordinators: Brandy Maschhaupt, Elizabeth Gleason. Medical College of South Carolina: Jimmy E. Couch, DO, Steven S. Glazier, MD, Jonathan J. Halford, MD, Justin M. Nolte, MD, Holly J. Skinner, DO, Mimi Sohn, MD; Coordinators: Jennifer Zimmerman, Amy Parker, RN, Kathleen Bradbury, RN. Baylor College of Medicine: Lyndon F.S. Barnwell, MD, PhD, David E. Friedman, MD, James D. Frost, Jr., MD, Alica M. Goldman, MD, PhD, Ian Lance Goldsmith, MD, Amit Verma, MD, Daniel Yoshor, MD; Coordinators: Melissa Lambeth, RN, Ronnie Tobias, NP-C. University of Rochester: Guiseppe Erba, MD, Robert A. Gross, MD, PhD, John Craig Henry, MD, Lynn C. Liu, MD, Webster H. Pilcher, MD, PhD, Jason M. Schwalb, MD; Coordinators: Diane Smith, Karen Sarosky. University of Virginia: William J. Elias, MD, Ilona S. Humes, MD, Paul D. Lyons, MD, Gabriel U. Martz, MD, Rhunnelle C. Murray, MD, Mark Quigg, MD, MS, Utku Uysal, MD, Christopher J. Wright, MD; Coordinators: Stacy Thompson, RN, Bruce Palmer. George Washington University: Anthony Caputy, MD, Samuel J. Potolicchio Jr., MD; Coordinators: Stacy Tam, Andria Bailey. Mayo Clinic Florida: David R. Chabolla, MD, Kent C. New, MD, PhD, Jerry J. Shih, MD, William Tatum, DO; Coordinators: Karey Doll, RN, PhD, Ellen Miceli, RN. Columbia University Medical Center: Hyunmi Choi, MD, MS, Daniel Friedman, MD, Robert R. Goodman, MD, PhD, Steven C. Karceski, MD; Coordinators: Alison Randall, Silvia Done, Emily Cohen, Rebecca Bausell. Mayo Clinic Rochester: Jeffrey W. Britton, MD, Gregory D. Cascino, MD, Gregory A. Worrell, MD, PhD; Coordinators: Cindy Nelson, Karla Crockett. Emory University: Charles M. Epstein, MD, Sandra L. Helmers, MD, Suzette M. LaRoche, MD, Kimford J. Meador, MD, Page B. Pennell, MD, Denise Taylor, DO; Coordinators: Emilee Holland, Kathryn Rahimzadeh, RN. Yale University School of Medicine: Pue Farooque, DO, Evan J. Fertig, MD, Alexander M. Papanastassiou, MD, Susan S. Spencer, MD, Dennis D. Spencer, MD, Kenneth P. Vives, MD; Coordinator: Jennifer Bonito. University of Florida, Gainesville: Jeffrey M. Chung, MD, George A. Ghacibeh, MD, Kimford J. Meador, MD, Steven N. Roper, MD; Coordinators: Denise Riley, NP, David Parfitt. Wake Forest University Health Sciences: William L. Bell, MD, FACP, Mary L. Campagna-Gibson, MD, Joao Carlos DeToledo, MD, Thomas L. Ellis, MD, Maria C. Sam, MD, MS, FAASM; Coordinators: Sara Vaughan, Charlotte Miller, Wendy Jenkins.

Metrics & Citations

Metrics

Citation information is sourced from Crossref Cited-by service.

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Deep brain stimulation, Encyclopedia of the Human Brain, (16-41), (2025).https://doi.org/10.1016/B978-0-12-820480-1.00212-6
    Crossref
  2. Functional Optical Coherence Tomography of Rat Cortical Neurovascular Activation during Monopulse Electrical Stimulation with the Microelectrode Array, Photonics, 11, 5, (420), (2024).https://doi.org/10.3390/photonics11050420
    Crossref
  3. Case report: Bridging limbic network epilepsy with psychiatric, memory, and sleep comorbidities: case illustrations of reversible psychosis symptoms during continuous, high-frequency ANT-DBS, Frontiers in Network Physiology, 4, (2024).https://doi.org/10.3389/fnetp.2024.1426743
    Crossref
  4. SeizNet: An AI-Enabled Implantable Sensor Network System for Seizure Prediction, 2024 19th Wireless On-Demand Network Systems and Services Conference (WONS), (57-60), (2024).https://doi.org/10.23919/WONS60642.2024.10449556
    Crossref
  5. Feasibility, Safety, and Performance of Full-Head Subscalp EEG Using Minimally Invasive Electrode Implantation, Neurology, 102, 12, (2024)./doi/10.1212/WNL.0000000000209428
    Abstract
  6. Qualitative Analysis of Decision to Pursue Electrical Brain Stimulation by Patients With Drug-Resistant Epilepsy and Their Caregivers, Neurology Clinical Practice, 14, 1, (2024)./doi/10.1212/CPJ.0000000000200245
    Abstract
  7. Neuromodulation: What the neurointerventionalist needs to know, Interventional Neuroradiology, (2024).https://doi.org/10.1177/15910199231224554
    Crossref
  8. The Best Things Happen When You Least Expect Them: Responsive Neurostimulation During Low-Risk Brain States is Associated with Improved Long-Term Seizure Suppression, Epilepsy Currents, 24, 5, (350-352), (2024).https://doi.org/10.1177/15357597241258287
    Crossref
  9. Combination of or Transition between Deep Brain Stimulation and Responsive Neurostimulation for the Treatment of Drug-Resistant Epilepsy, Stereotactic and Functional Neurosurgery, (1-11), (2024).https://doi.org/10.1159/000540431
    Crossref
  10. Epileptic Network Surgery: From Network Basis to Clinical Practice, Acta Neurologica Scandinavica, 2024, 1, (2024).https://doi.org/10.1155/2024/1735404
    Crossref
  11. See more
Loading...

View Options

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.

If you need immediate support or to place an order, please call or email customer service:

  • 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
  • 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
  • [email protected]

We appreciate your patience during this time and apologize for any inconvenience.

View options

PDF and All Supplements

Download PDF and Supplementary Material

Full Text

View Full Text

Full Text HTML

View Full Text HTML

Media

Figures

Other

Tables

Share

Share

Share article link

Share