Deep brain and cortical stimulation for epilepsy

Sprengers, Mathieu; Vonck, Kristl; Carrette, Evelien; Marson, Anthony G; Boon, Paul

doi:10.1002/14651858.cd008497.pub3

Cited by 70 publications

(55 citation statements)

References 129 publications

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“…Potential CNS targets for DBS previously evaluated in patients with epilepsy include the anterior and centromedian thalamic nuclei, hippocampus and cerebellum 10. The anterior nucleus of the thalamus (ANT) is a primary component of the Papez circuit.…”

Section: Introductionmentioning

confidence: 99%

Comparing neurostimulation technologies in refractory focal-onset epilepsy

Gooneratne

Green

Dugan

et al. 2016

J Neurol Neurosurg Psychiatry

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For patients with pharmacoresistant focal epilepsy in whom surgical resection of the epileptogenic focus fails or was not feasible in the first place, there were few therapeutic options. Increasingly, neurostimulation provides an alternative treatment strategy for these patients. Vagal nerve stimulation (VNS) is well established. Deep brain stimulation (DBS) and cortical responsive stimulation (CRS) are newer neurostimulation therapies with recently published long-term efficacy and safety data. In this literature review, we introduce these therapies to a non-specialist audience. Furthermore, we compare and contrast long-term (5-year) outcomes of newer neurostimulation techniques with the more established VNS. A search to identify all studies reporting long-term efficacy (>5 years) of VNS, CRS and DBS in patients with refractory focal/partial epilepsy was conducted using PubMed and Cochrane databases. The outcomes compared were responder rate, percentage seizure frequency reduction, seizure freedom, adverse events, neuropsychological outcome and quality of life. We identified 1 study for DBS, 1 study for CRS and 4 studies for VNS. All neurostimulation technologies showed long-term efficacy, with progressively better seizure control over time. Sustained improvement in quality of life measures was demonstrated in all modalities. Intracranial neurostimulation had a greater side effect profile compared with extracranial stimulation, though all forms of stimulation are safe. Methodological differences between the studies mean that direct comparisons are not straightforward. We have synthesised the findings of this review into a pragmatic decision tree, to guide the further management of the individual patient with pharmacoresistant focal-onset epilepsy.

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Section: Introductionmentioning

confidence: 99%

Comparing neurostimulation technologies in refractory focal-onset epilepsy

Gooneratne

Green

Dugan

et al. 2016

J Neurol Neurosurg Psychiatry

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show abstract

“…Electrical stimulation of deep brain structures (Deep Brain Stimulation, DBS) is a promising treatment option for refractory epilepsy patients [1,2]. Several brain structures involved in the epileptic network have been targeted and the hippocampus appears to be an effective target for the treatment of temporal lobe epilepsy (TLE) [3e7].…”

Section: Introductionmentioning

confidence: 99%

“…Clinical outcome of DBS in the hippocampal formation using various stimulation parameters has been reported both in patient trials [11e20] and in pre-clinical experiments [21e31] with variable results. Short-term randomized trials report moderate effects of 15% seizure rate reduction [16], while long-term trials demonstrate further improvement with time with efficacy ranging from 50% seizure reduction up to seizure freedom [1,13]. Further improvement in seizure control by means of hippocampal DBS is dependent on the search and the identification of optimal stimulation parameters and stimulation strategies to be applied in this region.…”

Section: Introductionmentioning

confidence: 99%

In Search of Optimal DBS Paradigms to Treat Epilepsy: Bilateral Versus Unilateral Hippocampal Stimulation in a Rat Model for Temporal Lobe Epilepsy

Nieuwenhuyse¹,

Raedt²,

Delbeke³

et al. 2015

Brain Stimulation

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“…Intrahippocampal stimulation for epilepsy has only been reported in few patients . However, according to a Cochrane meta‐analysis, hippocampal stimulation was not associated with significantly higher responder rates (>50% seizure reduction) compared to sham stimulation, and no single patient was seizure‐free for the duration of the three included RCTs.…”

Section: Current Indications For Cortex Stimulationmentioning

confidence: 99%