A Review of Neurostimulation for Epilepsy in Pediatrics

Abstract

Neurostimulation for epilepsy refers to the application of electricity to affect the central nervous system, with the goal of reducing seizure frequency and severity. We review the available evidence for the use of neurostimulation to treat pediatric epilepsy, including vagus nerve stimulation (VNS), responsive neurostimulation (RNS), deep brain stimulation (DBS), chronic subthreshold cortical stimulation (CSCS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). We consider possible mechanisms of action and safety concerns, and we propose a methodology for selecting between available options. In general, we find neurostimulation is safe and effective, although any high quality evidence applying neurostimulation to pediatrics is lacking. Further research is needed to understand neuromodulatory systems, and to identify biomarkers of response in order to establish optimal stimulation paradigms.

Altered amplitude of low‐frequency fluctuations and regional homogeneity in drug‐resistant epilepsy patients with vagal nerve stimulators under different current intensity

“…The observation in this study indicates that the cortical and subcortical structures with functional activity changes are important for VNS. Increased activity in the precentral/postcentral gyri, cingulate gyri, cerebellum, which is associated with motor execution and coordination, may also provide the available evidence for the use of neurostimulation to treat DRE, including transcranial magnetic stimulation (precentral gyrus as the target), cingulate cortex stimulation (cingulate cortex as the target), and cerebellar stimulation (cerebellum as the target) 34‐36 . In addition, our findings also support that 3.0T MRI is safe and beneficial for follow‐up of epilepsy patients with VNS 37 …”

Microglial contributions to aberrant neurogenesis and pathophysiology of epilepsy

“…Though originally believed to result in an increase in levels of GABA production [ 15 ] , there may be multiple mechanisms that contribute to its success in seizure cessation [ 16 ] . Neurostimulatory devices, such as deep brain or vagus nerve stimulation therapies, have also been used with varying success, as they help to normalize the excitatory state of the brain [ 17 ] .…”

Neurophysiological and Genetic Findings in Patients With Juvenile Myoclonic Epilepsy

“…Transcranial Magnetic Stimulation (TMS) is a painless, non-invasive neurophysiological technique stimulating the cortex without any current passing through the skin or the meninges of skull where most of the pain nerves are found ( Barker et al, 1985 ; Hameed et al, 2017 ; Starnes et al, 2019 ). There is generation of intracranial currents that can alter cortical excitability, evoking action potentials called Motor Evoked Potentials (MEP) and also providing information about synaptic interactions between neurons and local neuronal ( Rossini and Rossi, 2007 ; Rossi et al, 2009b ; Starnes et al, 2019 ). Results from TMS can illustrate connections between interneurons and motor neurons and discern biomarkers that can provide clues about cortical mechanisms involved in excitation and inhibition of the brain ( Rothwell, 1997 ; Tsuboyama et al, 2019 ).…”