A Pilot Study of High-Definition Transcranial Direct Current Stimulation in Refractory Status Epilepticus: The SURESTEP Trial

• Published in: Neurotherapeutics Vol. 20; no. 1; pp. 181 - 194
• Main Authors: Ng, Marcus C., El-Alawi, Hussam, Toutant, Darion, Choi, Eun Hyung, Wright, Natalie, Khanam, Manzuma, Paunovic, Bojan, Ko, Ji Hyun
• Format: Journal Article
• Language: English
• Published: Cham Elsevier Inc 01.01.2023; Springer International Publishing; Springer Nature B.V
• Subjects: Automation; Biomedical and Life Sciences; Biomedicine; Brain; Computer simulation; Convulsions & seizures; Drug dosages; EEG; Electrical stimulation of the brain; Electrodes; Electroencephalography; Epilepsy; ESB; Firing pattern; Humans; Intensive care; Internal medicine; Medicine; Mortality; Neurobiology; Neurology; Neurosciences; Neurosurgery; Original; Original Article; Patients; Pilot Projects; Research Design; Seizures; Software; Status Epilepticus - therapy; Transcranial Direct Current Stimulation - methods
• ISSN: 1878-7479; 1933-7213; 1878-7479
• DOI: 10.1007/s13311-022-01317-5

Refractory status epilepticus (RSE) is a life-threatening emergency with high mortality and poor functional outcomes in survivors. Treatment is typically limited to intravenous anesthetic infusions and multiple anti-seizure medications. While ongoing seizures can cause permanent neurological damage, medical therapies also pose severe and life-threatening side effects. We tested the feasibility of using high-definition transcranial direct current stimulation (hd-tDCS) in the treatment of RSE. We conducted 20-min hd-tDCS sessions at an outward field orientation, intensity of 2-mA, 4 + 1 channels, and customized for deployment over the electrographic maximum of epileptiform activity (“spikes”) determined by real-time clinical EEG monitoring. There were no adverse events from 32 hd-tDCS sessions in 10 RSE patients. Over steady dosing states of infusions and medications in 29 included sessions, median spike rates/patient fell by 50% during hd-tDCS on both automated (p = 0.0069) and human (p = 0.0277) spike counting. Median spike rates for any given stimulation session also fell by 50% during hd-tDCS on automated spike counting (p = 0.0032). Immediately after hd-tDCS, median spike rates/patient remained down by 25% on human spike counting (p = 0.018). Compared to historical controls, hd-tDCS subjects were successfully discharged from the intensive care unit (ICU) 45.8% more often (p = 0.004). When controls were selected using propensity score matching, the discharge rate advantage improved to 55% (p = 0.002). Customized EEG electrode targeting of hd-tDCS is a safe and non-invasive method of hyperacutely reducing epileptiform activity in RSE. Compared to historical controls, there was evidence of a cumulative chronic clinical response with more hd-tDCS subjects discharged from ICU.