The intention of this groundbreaking device is not only to stop seizures from happening but to prevent debilitating seizure symptoms, such as loss of consciousness.Joshua P. Aronson, MD
More than 3 million people in the United States live with epilepsy. Of those individuals, about one in six cannot control their seizures with medications or surgery alone. Uncontrolled seizures can lead to an unpredictable, diminished quality of life—without the ability to predict when a seizure might interrupt the day, cause loss of consciousness, or a medical emergency.
Dartmouth-Hitchcock Medical Center’s (DHMC) Department of Neurology and Section of Neurosurgery have partnered with the Yale School of Medicine and the Mayo Clinic to pioneer the Stimulation of the Thalamus for Arousal Restoral in Temporal lobe epilepsy (START) clinical trial—the first to implant neurostimulator devices targeting four specific areas of the brain. Following implantation, participants chosen for this study receive an Epilepsy Personal Assistant Device (EPAD) tablet computer to track seizures and epilepsy medications, as well as an Automatic Responsiveness Testing in Epilepsy (ARTiE) smartwatch, which asks the participant questions during a seizure to see if they are can respond, and determine if the neurostimulator is successfully preventing loss of consciousness.
On February 21, 2022, Jessica Sargent, a 34-year-old mother of an 11-year-old daughter and 7-year-old son from Barrington, NH, became the first START clinical trial participant nationwide to have a neurostimulator device implanted in her brain at DHMC.
“Most of the time, I have no idea when a seizure is going to happen,” Sargent said, adding that she blacked out from a seizure while giving birth to her daughter. “I seem to miss so much of my life.”
Sargent’s surgery was performed at DHMC by neurosurgeon and trial site investigator Joshua P. Aronson, MD, in collaboration with Barbara C. Jobst, MD, chair of the Dartmouth-Hitchcock Department of Neurology and Neurocritical Care and principal site investigator of START; and Hal Blumenfeld, MD, PhD, director of the Yale Clinical Neuroscience Imaging Center, a renowned scientist in consciousness research, and the leader of the national START study. The surgery involved precise placement of neurostimulator electrodes in four brain areas, relying on advanced neurosurgical targeting performed in the Center for Surgical Innovation at DHMC.
Sargent developed epilepsy at 19 and, prior to her surgery, was experiencing as many as three seizures every month. She was unable to work, and her condition caused anxiety in her daily life—not knowing if she could do something as simple as taking her children outside to play without experiencing a seizure.
When Sargent was told that the START trial could give her a chance to remain coherent through seizures, she knew this could be the solution she’s spent 15 years searching for. Three weeks out from her surgery and recovering, she has a positive outlook for her life going forward—and the potential START could have for others with epilepsy.
“When they said I’d be able to help other people, it clicked because I don’t want anyone else to have to go through this,” Sargent said. “It’s been so long since I’ve been having seizures and now with the neurostimulator device, I’m very hopeful.”
The advent of neuromodulation technology in the last decade has been a major step forward in how epilepsy is treated—changing the way the brain networks from inside via an implanted neurostimulator device—but further improvement was needed. Previously, implanted devices would target just two regions of the brain to reduce, but not eliminate seizures. Most patients continue to experience seizures with loss of consciousness. This novel procedure is set to change that.
“The intention of this groundbreaking device is not only to stop seizures from happening but to prevent debilitating seizure symptoms, such as loss of consciousness,” Aronson said. “Ideally, if the device can’t stop the seizure, it will transform how the person experiences it and keep them awake and aware. They may not even know they’re having a seizure because of this new neurostimulator.”
“While everyday tasks like cooking dinner, walking our children to the bus stop, or merely not having to worry that you might lose consciousness without warning, are not causes for concern for most people, for people living with epilepsy, these are real fears they live with constantly,” Jobst said. “The START study offers a chance at normalcy, something most of us take for granted, for epilepsy patients. We’re tremendously grateful that Jessica stepped up and volunteered to be the first to have this procedure, paving the way for others and making her just as critical to START’s success as its investigators. As northern New England’s only Level-4 epilepsy center, DHMC is uniquely poised to be a leader in novel epilepsy treatments, and we look forward to continuing to work with Yale and Mayo Clinic to make this life-changing procedure a reality for epilepsy patients everywhere.”
DARTMOUTH-HITCHCOCK HEALTH (D-HH), New Hampshire’s only academic health system and the state’s largest private employer, serves a population of 1.9 million across Northern New England. D-H provides access to more than 2,400 providers in almost every area of medicine, delivering care at its flagship hospital, Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH. DHMC was named in 2019 as the #1 hospital in New Hampshire by U.S. News & World Report, and recognized for high performance in 13 clinical specialties and procedures. Dartmouth-Hitchcock Health also includes the Norris Cotton Cancer Center, one of only 51 NCI-designated Comprehensive Cancer Centers in the nation; the Children's Hospital at Dartmouth-Hitchcock, the state’s only children’s hospital; affiliated member hospitals in Lebanon, Keene, and New London, NH, and Windsor, VT, and Visiting Nurse and Hospice for Vermont and New Hampshire; and 24 Dartmouth-Hitchcock clinics that provide ambulatory services across New Hampshire and Vermont. The D-H system trains nearly 400 residents and fellows annually, and performs world-class research, in partnership with the Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center in White River Junction, VT.