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

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

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

4. Seizure is a loss of brain processing complexity
complicated
simple

5. 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

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

7. 302 (hermaphrodyte) or 353 neurons (male)

9. probabilistic tractography, cortical thickness correlations, connectivity

10. The brain is a complex dynamic network

11. ablative
VNS
RNS

12. Surgical Removal or Disconnection

13. VNS - Vagus Nerve Stimulation

14. RNS - Responsive Neuro-Stimulaiton

20. ↯ ✘
2-Stage
1-Stage

21. 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

22. 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

23. 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

24. 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 or
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.

25. 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