Deep brain stimulation for drug‐resistant epilepsy

Li, Michael C. H.; Cook, Mark

doi:10.1111/epi.13964

Cited by 235 publications

(226 citation statements)

References 79 publications

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“…There was a trend for patients in the SANTE trial who had frontal or temporal foci to have greater seizure reduction compared to those with foci in other lobes . It is unclear at this time if this is related to the functional connectivity of ANT, and some authors propose other thalamic targets such as centromedian nucleus for the treatment of extralimbic epilepsies …”

Section: Discussionmentioning

confidence: 99%

Responsive neurostimulation targeting the anterior nucleus of the thalamus in 3 patients with treatment‐resistant multifocal epilepsy

Elder¹,

Friedman²,

Devinsky³

et al. 2019

Epilepsia Open

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Summary Electrical stimulation in the anterior nucleus of the thalamus (ANT) has previously been found to be efficacious for reducing seizure frequency in patients with epilepsy. Bilateral deep brain stimulation (DBS) of the ANT is an open‐loop system that can be used in the management of treatment‐resistant epilepsy. In contrast, the responsive neurostimulation (RNS) system is a closed‐loop device that delivers treatment in response to prespecified electrocorticographic triggers. The efficacy and safety of RNS targeting the ANT is unknown. We describe 3 patients with treatment‐resistant multifocal epilepsy who were implanted with an RNS system, which included unilateral stimulation of the ANT. After >33 months of follow‐up, there were no adverse effects on mood, memory or behavior. Two patients had ≥50% reduction in disabling seizures and one patient had a 50% reduction compared to pretreatment baseline. Although reduction in seizure frequency has been modest to date, these findings support responsive neurostimulation of the ANT as feasible, safe, and well‐tolerated. Further studies are needed to determine optimal stimulation parameters.

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Section: Discussionmentioning

confidence: 99%

Responsive neurostimulation targeting the anterior nucleus of the thalamus in 3 patients with treatment‐resistant multifocal epilepsy

Elder¹,

Friedman²,

Devinsky³

et al. 2019

Epilepsia Open

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show abstract

“…In the context of epilepsy, it is important to understand the genetics and cell signaling aspects of underpinning seizures and additional morbidities, but this does not subsume all other approaches to treatment. For example, stimulation approaches have been developed in animals 23,[32][33][34][35][36][37] and the clinic [24][25][26] to detect seizures and acutely and directly modulate neural firing. Electrical stimulation approaches are used in animals and humans.…”

Section: Definition Of Mechanismsmentioning

confidence: 99%

WONOEP APPRAISAL: The many facets of epilepsy networks

et al. 2018

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The brain is a complex system composed of networks of interacting elements, from genes to circuits, whose function (and dysfunction) is not derivable from the superposition of individual components. Epilepsy is frequently described as a network disease, but to date, there is no standardized framework within which network concepts applicable to all levels from genes to whole brain can be used to generate deeper insights into the pathogenesis of seizures or the associated morbidities. To address this shortcoming, the Neurobiology Commission of the International League Against Epilepsy dedicated a Workshop on Neurobiology of Epilepsy (XIV WONOEP 2017) with the aim of formalizing network concepts as they apply to epilepsy and to critically discuss whether and how such concepts could augment current research endeavors. Here, we review concepts and strategies derived by considering epilepsy as a disease of different network hierarchies that range from genes to clinical phenotypes. We propose that the concept of networks is important for understanding epilepsy and is critical for developing new study designs. These approaches could ultimately facilitate the development of novel diagnostic and therapeutic strategies.

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“…Thus, a new therapeutic approach is desired. Deep brain stimulation (DBS) has been employed to treat neurological and psychiatric disorders including epilepsy (8). Direct stimulation of the hippocampus (HPC) can reduce seizure occurrence especially in medial TLE (8,9).…”

mentioning

confidence: 99%

“…Deep brain stimulation (DBS) has been employed to treat neurological and psychiatric disorders including epilepsy (8). Direct stimulation of the hippocampus (HPC) can reduce seizure occurrence especially in medial TLE (8,9). However, because the HPC is a relatively large bilateral structure, direct electrical stimulation may affect only a small portion of the seizure generating structure (10).…”

mentioning

confidence: 99%

Closed-loop stimulation of the medial septum terminates epileptic seizures

Takeuchi

Harangozó

Pedraza

et al. 2020

Preprint

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Temporal lobe epilepsy with distributed hippocampal seizure foci is often intractable and its secondary generalization might lead to sudden death. Early termination through spatially extensive hippocampal intervention is not feasible directly, due to its large size and irregular shape. In contrast, the medial septum (MS) is a promising target to govern hippocampal oscillations through its divergent connections to both hippocampi. Combining this 'proxy intervention' concept and precisely timed stimulation, we report here that closed-loop MS electrical stimulation can quickly terminate intrahippocampal seizures and suppress secondary generalization in a rat kindling model. Precise stimulus timing governed by internal seizure rhythms was essential. Cell-type-specific stimulation revealed that precisely timed activation of MS GABAergic neurons underlay the effects. Our concept of phase-targeted proxy stimulation for intervening pathological oscillations can be extrapolated to other neurological and psychiatric disorders, and its current embodiment can be directly translated into clinical application.

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Deep brain stimulation for drug‐resistant epilepsy

Cited by 235 publications

References 79 publications

Responsive neurostimulation targeting the anterior nucleus of the thalamus in 3 patients with treatment‐resistant multifocal epilepsy

Responsive neurostimulation targeting the anterior nucleus of the thalamus in 3 patients with treatment‐resistant multifocal epilepsy

WONOEP APPRAISAL: The many facets of epilepsy networks

Closed-loop stimulation of the medial septum terminates epileptic seizures

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