Intermountain Health neurologists are celebrating a major milestone: the 100th surgery of a groundbreaking implantable device that is proving to be a major success in reducing seizures in patients with patients with focal epilepsy.

The device – responsive neurostimulation (RNS), which is manufactured by Neuropace – uses electrodes placed on the brain surface or in deeper brain areas to monitor brain waves 24/7.

When the device detects abnormal activity, it quickly sends an impulse that stops it from spreading and becoming a seizure. Some studies have shown an 82 percent reduction in the number of seizures for patients.

Doctors at Intermountain Medical Center in Murray, where the device has been implanted, are already seeing life-changing results for patients with epilepsy – most of whom didn’t respond to other treatments in the past.

“This is making an incredible difference in the lives of people who have suffered with seizures for years when other treatments haven’t worked,” said Jeff Bigelow, MD, medical director of EEG systems at Intermountain Health and a neurologist at Intermountain Medical Center who specializes in the treatment of patients with epilepsy and seizure disorders. “Seeing these levels of improvement in seizure control and overall quality of life is very encouraging for both us and our patients.”

Long term studies show 3 out of 4 patients implanted with the device experience a 50 percent or greater reduction in seizures. Other studies have shown the average reduction in seizures reached up to 82 percent after three years or more. The device’s battery lasts up to 10 years.

Whitney Wilkinson of Sandy has been dealing with epilepsy since she was 12 years old and experienced years of treatments and multiple surgeries to try and manage her seizures.  

Five years ago, neurosurgeons at Intermountain Medical Center told her about the RNS device and how it could help her. Since then, she’s seen a dramatic reduction in her seizures.

“I literally have a computer in my brain that monitors activity 24/7, learns to detect seizures, and stops them milliseconds before happening,” said Wilkinson. “Thanks to this and other treatments from my doctors I feel confident traveling the world on my own and living a normal life with epilepsy.”

Wilkinson can also upload data from her device so that doctors can adjust it in real time to better control her seizures. All of this takes place without neurosurgeons having to go back into the brain surgically.

Since gaining FDA approval in 2013, RNS devices have been used to treat focal epilepsy, which is a seizure disorder that occurs in a localized part of the brain and can spread causing more severe symptoms.

Early signs of focal epilepsy can look like twitching of a limb or staring off in confusion.

Generalized epilepsy starts in both parts of the brain and can cause more severe symptoms like convulsions and losing consciousness. After the recent success of RNS devices, the FDA is now reviewing whether it can be used for those conditions.

“After seeing the success in the reduction of the symptoms our patients, I’m hopeful this could be an option for any patient with difficult to treat forms of epilepsy,” said Dr. Bigelow. “For many patients the fear of now knowing when or how bad a seizure can be gives them a constant anxiety in life and we want to change that.”

Dr. Bigelow notes the devices do take time to work to their full potential. They must monitor symptoms and adjust to fit a patient’s specific needs, which can take one to three years.

The Intermountain Epilepsy Clinic is part of the Intermountain Medical Center Neurosciences Institute. The program specializes in diagnosing and treating epilepsy and seizure disorders in adolescents and adults, and is a Level 4 Adult Epilepsy Center, the highest designation awarded by the National Association of Epilepsy Centers (NAEC).

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Cuando se trata de un accidente cerebrovascular, cada segundo cuenta. Para los pacientes con accidentes cerebrovasculares isquémicos, recibir medicamentos lo antes posible para disolver los coágulos y restablecer el flujo sanguíneo al cerebro es fundamental porque cada minuto que pasa significa que más células cerebrales son privadas de oxígeno y posiblemente se pierdan.   

Si bien la práctica basada en evidencia a menudo se entiende claramente, la coordinación necesaria para mejorar la administración oportuna de los medicamentos para disolver coágulos presenta desafíos de implementación únicos para los sistemas de atención médica.

Ahora un nuevo estudio de investigadores de neurología y científicos de implementación de Intermountain Health demuestra que cuando se implementa un protocolo de accidentes cerebrovasculares en todo el sistema con un grado de adaptación local en un sistema de salud, el tiempo de tratamiento para los pacientes con accidentes cerebrovasculares en todos los hospitales afectados mejora significativamente, lo que les brinda a los pacientes una mayor posibilidad de supervivencia y recuperación. 

Para el estudio, los líderes de neurología de Intermountain trabajaron para ayudar a cada uno de los hospitales de Intermountain, rurales y urbanos, grandes y pequeños, a personalizar la implementación de protocolos para que se adapten al entorno único y la población de pacientes de ese hospital. 

Casi todos los hospitales participantes notaron una caída drástica en la brecha entre la llamada de ayuda de un paciente y la administración del medicamento para disolver coágulos, tPA. Varios hospitales mejoraron en más de 20 minutos, lo que se traduce en muchas células cerebrales salvadas.

Los hallazgos del nuevo estudio que examina la implementación en todo el sistema están publicados este mes en la revista Circulation: Cardiovascular Quality and Outcomes.

“Queremos proporcionar la misma atención de accidentes cerebrovasculares de alta calidad en todo nuestro sistema de atención médica, ya sea que acuda a nuestro hospital urbano insignia o a un hospital rural pequeño que tal vez solo atienda a pacientes que necesitan un medicamento tPA una o dos veces al año”, dijo Kathleen McKee, MD, coautora principal del estudio y directora médica adjunta de investigación de neurociencias en Intermountain Healthcare. “Esta investigación muestra que nos estamos acercando a esa realidad”. 

“La administración de atención de accidentes cerebrovasculares agudos es compleja en un departamento de emergencias. Esto puede presentar desafíos para los médicos clínicos que buscan brindar atención de alta calidad para cada paciente. En este estudio, descubrimos que definir principalmente ‘qué’ debía ocurrir en todos los departamentos de emergencias, y a la vez proporcionarle a cada sitio flexibilidad o adaptación a sus circunstancias locales condujo a una mejor atención en todos los sitios”, señaló Andrew Knighton, PhD, un científico de implementación y coautor principal del estudio.   

El estudio involucró a 21 departamentos de emergencias de Intermountain Health en Utah y Idaho, de los cuales cuatro eran centro especializados de accidentes cerebrovasculares. Para el estudio, cada hospital recibió estrategias de implementación de atención de accidentes cerebrovasculares agudos para proporcionar el medicamento tPA a los pacientes adecuados lo antes posible, ya que una investigación anterior demostró que el tPA administrado dentro de las seis horas de un accidente cerebrovascular aumenta significativamente las probabilidades de que alguien sobreviva a un accidente cerebrovascular y reduce las probabilidades de discapacidad. 

Cada hospital trabajó con un equipo central de Intermountain Health para proponer qué estrategias de implementación funcionarían mejor para el despliegue del protocolo dentro de su departamento de emergencias. Esto provocó que cada departamento de emergencias propusiera soluciones de implementación únicas adaptadas específicamente a sus necesidades y las de sus pacientes para la administración oportuna de tPA. 

En el estudio, los investigadores registraron la eficacia de la implementación del programa de atención de accidentes cerebrovasculares agudos desde enero de 2018 hasta febrero de 2020. Durante ese tiempo, los departamentos de emergencias de dichos hospitales tuvieron 855,474 encuentros con pacientes, con 5,325 activaciones de código de accidente cerebrovascular. De esos pacientes, 615 recibieron tPA en menos de tres horas de la aparición de los síntomas. 

El equipo de investigación midió los tiempos puerta-aguja, o el tiempo desde que un paciente llega al departamento de emergencias hasta que la aguja intravenosa administra tPA.   

El estudio demostró que el porcentaje de tiempos puerta-aguja por debajo de los 60 minutos aumentó del 72.5% al 86.1%. Los investigadores también hallaron la mayor mejora en los departamentos de emergencias de centros no especializados en accidentes cerebrovasculares rurales y fronterizos. 

“Esto sugiere que pueden existir diferencias contextuales adicionales entre los departamentos de emergencias de centros no especializados en accidentes cerebrovasculares que deben comprenderse mejor, tal vez impulsadas por las diferencias en los volúmenes de pacientes, el liderazgo y la toma de decisiones de los sitios, las dinámicas de los equipos y los recursos”, señaló Knighton.

En general, los investigadores de Intermountain indicaron que el estudio demuestra que se puede utilizar un enfoque centralizado pero personalizado a nivel local para mejorar la atención de accidentes cerebrovasculares agudos en departamentos de emergencias muy diversos. 

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When it comes to a stroke, every second counts. For patients with ischemic strokes, getting medication as quickly as possible to break up clots and restore blood flow to the brain is critical because every passing minute means more brain cells are deprived of oxygen and possibly lost. 

While the evidence-based practice is often clearly understood – the coordination required to improve timely delivery of clot-busting medication presents unique implementation challenges for healthcare delivery systems.

Now, a new study from neurology researchers and implementation scientists at Intermountain Health demonstrates that when a systemwide stroke protocol is implemented with a degree of local tailoring across a health system, treatment time for stoke patients at all impacted hospitals significantly improves giving patients a better chance at survival and recovery.

For the study, neurology leaders at Intermountain worked to empower each of the Intermountain hospitals – rural and urban, large and small – to customize the implementation of protocols to fit that hospital’s unique environment and patient population.

Nearly all participating hospitals saw a dramatic drop in the gap between when a patient calls for help, and when clot-busting medication, tPA, is administered. Several hospitals improved by more than 20 minutes – which translates into a lot of brain cells saved.

Findings from the new study examining the systemwide implementation are published this month in the journal, Circulation: Cardiovascular Quality and Outcomes.

“We want to provide the same high quality stroke care throughout our entire healthcare system, whether you come into our flagship urban hospital, or a small rural hospital that might only see patients who need tPA medication once or twice a year,” said Kathleen McKee, MD, co-lead author of the study and associate medical director of neurosciences research at Intermountain Healthcare. “This research shows we’re getting closer to that reality.”

“The delivery of acute stroke care is complex within an emergency department. This can present challenges for clinicians seeking to deliver high quality care for each patient. In this study, we found that defining centrally ‘what’ needed to happen across all emergency departments, while providing each site with flexibility or tailoring to their local circumstances led to better care across all sites,” said Andrew Knighton, PhD, an implementation scientist and co-lead author on the study. 

The study involved 21 Intermountain Health emergency departments in Utah and Idaho, with four being dedicated stroke centers. For the study, each hospital site received acute stroke care implementation strategies to get tPA medication to appropriate patients as soon as possible, as previous research has shown that tPA given within six hours of a stroke significantly increases the chance of someone surviving a stroke and reduces chances of disability.

Each hospital worked with a central Intermountain Health team to brainstorm what implementation strategies would work best for deployment of the protocol within their emergency department. This led to each emergency department coming up with unique implementation solutions specifically tailored to their and their patients’ needs for timely tPA delivery.

In the study, researchers tracked the effectiveness of the acute stroke care program’s implementation from January 2018 to February 2020. During that time, those hospital emergency departments had 855,474 patient encounters, with 5,325 code stroke activations. Of those, 615 patients received tPA in less than three hours of symptom onset.

The research team measured door-to-needle (DTN) times—or the time from when a patient arrives in the emergency department to the time the intravenous needle delivers tPA.  

The study demonstrated that the percentage of DTN times under 60 minutes increased from 72.5% to 86.1%. Researchers also found the biggest improvement in rural and frontier non-stroke center emergency departments.

“This suggests further contextual differences may exist between non-stroke center emergency departments that need to be better understood, driven perhaps by differences in patient volumes, site leadership and decision-making, team dynamics, and resources,” said Knighton.

Overall, the Intermountain researchers say the study demonstrates that a centrally led but locally customized approach can be utilized to improve acute stroke care across very diverse emergency departments.

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