Author

J. Alcala-Zermeno

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Review Sep 2026

Status of presurgical evaluation among patients with drug-resistant epilepsy identified with a computable electronic health record algorithm.

OBJECTIVE Drug-resistant epilepsy (DRE) is associated with increased injury risk, cognitive decline, psychiatric illness, and premature death. Epilepsy surgery can be curative among well-selected individuals but remains underutilized. This study sought to identify people living with DRE in electronic health record (EHR) data and determine factors associated with initiation of presurgical evaluation. METHODS Using a computable phenotypic algorithm, we identified people with probable DRE and an encounter in our medical system's EHR between 4/1/2020 and 6/1/2022. We randomly sampled 200 people for manual chart abstraction by two independent reviewers. People with confirmed DRE were classified according to stage in the presurgical evaluation care pathway. Demographic and clinical variables were tested for association with initiation of presurgical evaluation. RESULTS The algorithm identified 3,027 people with probable DRE. Among 200 randomly sampled people, 87.5% (n = 175) had epilepsy, 42% (n = 84) had DRE, and 11.5% (n = 23) had epilepsy with undefined drug responsiveness. Among those with DRE, 57.1% (n = 48) had not initiated presurgical evaluation. Presurgical evaluation was associated with co-morbid mood disorder (OR = 3.88, 95% CI = 1.5-10.3, p = 0.007), shorter median time since last epilepsy-related visit (2.40 months, IQR: 0.72-6.60 vs 6.96 months, IQR: 3.00-21.84, p = 0.003) and 2nd to last epilepsy visit (8.76 months, IQR: 4.78-15.36 vs 13.08 months and IQR: 7.32-28.32, p = 0.008), and tracking by a surgical coordinator (OR = 46.00, 95% CI = 9.5-222.5, p < 0.001). Unknown MRI classification (OR = 0.04, 95% CI = 0.0-0.4, p = 0.001) and generalized seizures (OR = 0.04, 95% CI = 0.0-0.29, p < 0.001) were associated with lower odds of evaluation. CONCLUSIONS An EHR algorithm can identify people with DRE and undefined drug responsiveness with potentially modifiable gaps in care.

Grace B. Simmons, C. Ekanayake, Brianna M. Peet et al. · Epilepsy & Behavior · 0 citations

Open access Sep 2026

Invasive network neuromodulation for insular epilepsy: A three-center retrospective study.

To characterize invasive neuromodulation for insular drug-resistant epilepsy, we retrospectively evaluated 22 patients treated with responsive neurostimulation (RNS; n = 14) or chronic subthreshold stimulation (CSS; n = 8). Stereoelectroencephalography was performed in 20 cases (91%). Median baseline seizure frequency was 10.5/month. Forty-one percent had prior epilepsy surgery. At year 3, median seizure reduction (MSR) was 83% (p = .01, Wilcoxon signed-rank test), with a responder rate (RR) of 77%; MSR was 92% for CSS and 75% for RNS. There were no significant differences in MSR (p ≥ .4) or RR (p > .9) when comparing RNS versus CSS. Three patients achieved seizure freedom by year 3. Patients undergoing combined insular-thalamic stimulation (n = 5) demonstrated an MSR of 84%, 86%, and 88% at 1, 2, and 3 years; seizure reduction in thalamocortical versus cortical-only stimulation was not different (p ≥ .1). Parasagittal lead trajectories achieved closer insular proximity than transopercular trajectories (p < .0001, Mann-Whitney U-test). Median charge density at last follow-up was 1.3 μC/cm2. There were no acute surgical complications and all stimulation-related side effects resolved with programming adjustments. This study expands the limited literature on insular neuromodulation by demonstrating effectiveness of RNS and CSS, suggesting potential benefit from combined thalamocortical targeting, and defining parasagittal trajectories as a surgical approach for optimal lead proximity.

Raunak Singh, N. Gregg, K. Starnes et al. · Epilepsia · 0 citations