Deep brain stimulation for medically refractory epilepsy

Ellis, Thomas L.; Stevens, Andrew

doi:10.3171/foc/2008/25/9/e11

Cited by 41 publications

(17 citation statements)

References 88 publications

(117 reference statements)

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“…The vast majority of the animal experimental studies but also the clinical trials have used the cerebellum cortical surface as stimulation target, with frequently contradictory results. 8,5,[14][15][16]22,23,38,48,52,53 However, the stimulation of the deep cerebellar nuclei appears to provide more solid data and better seizure control. 1,35 There are several mechanisms that may explain this discrepancy in the results of the cortical CS in animal and human studies.…”

Section: Discussionmentioning

confidence: 99%

“…9,29,40,61 The output of the cerebellum to the ascending reticular formation may be implicated in the inhibitory effect of the cerebellum to the basal ganglia neuronal network, which results in decreased activity of the excitatory thalamocortical projections. 9,16 This process ultimately results in inhibition of cortical excitability. There is a wide variation in the animal models used, the seizure induction methodology, the exact stimulation target, the stimulation methodology, and the stimulation parameters.…”

Section: Animal Experimental Studiesmentioning

confidence: 99%

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Cerebellar stimulation in the management of medically intractable epilepsy: a systematic and critical review

Fountas¹,

Kapsalaki²,

Hadjigeorgiou

2010

FOC

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Object The wide application of deep brain stimulation in the management of movement as well as other degenerative neurological and psychiatric disorders has renewed the interest in using deep brain stimulation in the management of medically intractable epilepsy. Various stimulation targets have been used with significantly varying results in aborting seizure activity. Electrical cerebellar stimulation (CS) has been used for more than 50 years in the management of epilepsy, with conflicting results. In the current study, the authors review the pertinent literature to outline the role of CS in the management of medically refractory epilepsy. Methods The PubMed medical database was systematically searched for the following terms: “cerebellar,” “epilepsy,” “stimulation,” and “treatment,” and all their combinations. Case reports were excluded from this study. Results The pertinent articles were categorized into 2 large groups: animal experimental and human clinical studies. Particular emphasis on the following aspects was given when reviewing the human clinical studies: their methodological characteristics, the number of participants, their seizure types, the implantation technique and its associated complications, the exact stimulation target, the stimulation technique, the seizure outcome, and the patients' psychological and social poststimulation status. Three clinical double-blind studies were found, with similar implantation surgical technique, stimulation target, and stimulation parameters, but quite contradictory results. Two of these studies failed to demonstrate any significant seizure reduction, whereas the third one showed a significant poststimulation decrease in seizure frequency. All possible factors responsible for these differences in the findings are analyzed in the present study. Conclusions Cerebellar stimulation seems to remain a stimulation target worth exploring for defining its potential in the treatment of medically intractable epilepsy, although the data from the double-blind clinical studies that were performed failed to establish a clear benefit in regard to seizure frequency. A large-scale, double-blind clinical study is required for accurately defining the efficacy of CS in epilepsy treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Animal Experimental Studiesmentioning

confidence: 99%

Cerebellar stimulation in the management of medically intractable epilepsy: a systematic and critical review

Fountas¹,

Kapsalaki²,

Hadjigeorgiou

2010

FOC

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“…Although larger than most other DBS targets, and therefore potentially more prone to targeting error and variability, the hippocampus is often stereotactically accessed with recording electrodes and consequently is a relatively familiar target for epilepsy surgeons. Several studies of hippocampal slices and rodent models provided preclinical support for hippocampal DBS [22,36,58,59]. The first systematic human studies of hippocampal stimulation came from Velasco and colleagues, initially in a pilot study of stimulation prior to temporal lobectomy in 10 patients [27].…”

Section: Hippocampal Formationmentioning

confidence: 99%

Deep Brain Stimulation for the Treatment of Epilepsy: Circuits, Targets, and Trials

2014

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Deep brain stimulation (DBS) has proven remarkably safe and effective in the treatment of movement disorders. As a result, it is being increasingly applied to a range of neurologic and psychiatric disorders, including medically refractory epilepsy. This review will examine the use of DBS in epilepsy, including known targets, mechanisms of neuromodulation and seizure control, published clinical evidence, and novel technologies. Cortical and deep neuromodulation for epilepsy has a long experimental history, but only recently have better understanding of epileptogenic networks, precise stereotactic techniques, and rigorous trial design combined to improve the quality of available evidence and make DBS a viable treatment option. Nonetheless, underlying mechanisms, anatomical targets, and stimulation parameters remain areas of active investigation.

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“…Among the most common targets investigated in adult DBS studies are the hippocampus, subthalamic nucleus, and thalamus. 14,19 Among these studies, Velasco et al 48 demonstrated that hippocampal stimulation reduced interictal spikes as well as the frequency of complex partial and tonic-clonic seizures in patients with medically refractory temporal lobe epilepsy. Benabid et al 5 treated a child with inoperable cortical dysplasia and refractory epilepsy with subthalamic nucleus DBS and observed an 83% improvement in seizure frequency as well as improvement of motor function.…”

Section: Epilepsymentioning

confidence: 99%

Current and future indications for deep brain stimulation in pediatric populations

Lipsman¹,

Ellis²,

Lozano³

2010

FOC

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Deep brain stimulation (DBS) has proven to be an effective and safe treatment option in patients with various advanced and treatment-refractory conditions. Thus far, most of the experience with DBS has been in the movement disorder literature, and more specifically in the adult population, where its use in conditions such as Parkinson disease has revolutionized management strategies. The pediatric population, however, can also be afflicted by functionally incapacitating neurological conditions that remain refractory despite the clinicians' best efforts. In such cases, DBS offers an additional treatment alternative. In this paper, the authors review their institution's experience with DBS in the pediatric population, and provide an overview of the literature on DBS in children. The authors conclude that DBS in children can and should be considered a valid and effective treatment option, albeit in highly specific and carefully selected cases.

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Deep brain stimulation for medically refractory epilepsy

Cited by 41 publications

References 88 publications

Cerebellar stimulation in the management of medically intractable epilepsy: a systematic and critical review

Cerebellar stimulation in the management of medically intractable epilepsy: a systematic and critical review

Deep Brain Stimulation for the Treatment of Epilepsy: Circuits, Targets, and Trials

Current and future indications for deep brain stimulation in pediatric populations

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