Acute Effects of Focused Ultrasound Modulation on EEG Behavior in Status Epilepticus Patients

Study Overview
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Brief Summary
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In this study, the investigators propose Pulsed Low-Intensity Focused Ultrasound (PLIFU) stimulation of brain regions that modulate (thalamus) or generate focal motor seizures (primary motor cortex), with the goal of ameliorating seizure activity in subjects in non-convulsive or focal motor status epilepticus. The course of treatment will consist of an initial 10 minute PLIFU treatment session with an option for a 2nd session if necessary. The primary objective of this study is to determine whether PLIFU reduces or suppresses epileptic activity in patients with Non-Convulsive Status Epilepticus (NCSE)/Focal Motor Status Epilepticus (FMSE) that have not responded to standard of care.

Detailed Description
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This study proposes to sonicate epileptic zones or circuits at the bedside with a custom built PLIFU device in two groups of participants experiencing non-convulsive seizures while treated in the Intensive Care Unit (ICU): 1) non-convulsive SE or 2) focal motor Status Epilepticus (SE), targeting the thalami or motor cortical areas responsible for generating ictal activity, respectively. PLIFU modulation is non-ablative, nonionizing, and noninvasive, while it also preserves the integrity and function of brain tissue. The aim is to quantify ictal and interictal EEG before, during, and after sonication. Experiments will not alter the standard of care and only be implemented after antiseizure medications (ASMs) have been delivered to the patient. PLIFU sonication will be delivered to participants using burst tone and nonthermal parameters for 10 minute exposures. Hypothesis: PLIFU is a safe and non-invasive treatment that can reduce or suppress epileptic activity. The pilot data acquired is intended to be used as preliminary data for justifying a larger study.

Official Title
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Acute Effects of Focused Ultrasound Modulation on EEG Behavior in Status Epilepticus Patients

Conditions
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Seizures

Intervention / Treatment
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* Device: PLIFU


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subjects diagnosed with ongoing NCSE or FMSE despite treatment with at least 2 ASMs Provision of signed and dated informed consent form obtained from the next-of-kin/legally authorized representative Treated in the ICU while monitored with continuous scalp EEG electrodes Exclusion Criteria: Unable to obtain informed consent Presence of an implanted cranial neuromodulation device for treatment of epilepsy Pregnancy Treatment with another investigational drug or other intervention within 24 hr Presence of burr hole(s) or craniotomy Subjects with ferromagnetic materials in the head Subjects with a TENS unit

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Adult patients with ongoing non-convulsive or focal motor SE despite treatment with standard of care antiseizure medications.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Participants with ongoing non-convulsive or focal motor SE<br>Adult patients with ongoing non-convulsive or focal motor SE despite treatment with at least 2 ASMs and who are monitored with surface EEG will be screened and enrolled to receive up to 2 sessions of PLIFU. | Device: PLIFU<br>* Participants will be treated with up to 2 sessions of PLIFU (on the same day), while monitored with surface EEG and will be observed for the remainder of the hospital stay as deemed by the primary care team. The system non-invasively delivers ultrasound sonications intracranially that selectively target specific areas of the brain.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in epileptiform activity | To determine the effect of PLIFU (duration of 10 minutes) on epileptic activity in participants with NCSE/FMSE that have not responded to standard of care using continuous surface EEG. A reduction or suppression of epileptic activity indicates a positive outcome. | baseline and 10 minutes |