Deep Brain Stimulation for Treatment of Refractory Epilepsy

Oliveira, Tatiana von Hertwig Fernandes de; Cukiert, Arthur

doi:10.4103/0028-3886.302454

Cited by 3 publications

(3 citation statements)

References 79 publications

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“…Basic mechanisms behind DBS effects on seizures are not fully understood, but it has been hypothesized that stimulation reduces propagation of ictal (and inter‐ictal) epileptic activity in the Circle of Papez, of which ANT is a part 11 . As seizure reduction during ANT stimulation is a possible indicator of network normalization, it is reasonable to assume that patients who have seizure reduction also can have improved cognitive performance.…”

Section: Discussionmentioning

confidence: 99%

Cognitive change after DBS in refractory epilepsy: A randomized‐controlled trial

Heminghyt

Herrman

Skogan

et al. 2021

Acta Neuro Scandinavica

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Objectives Deep brain stimulation of the anterior thalamic nucleus (ANT‐DBS) reduces seizure frequency in patients with refractory epilepsy. There are, however, few studies on treatment‐related changes in cognitive functions. The main objective of this study was to investigate cognitive changes in patients receiving ANT‐DBS. We also explored whether possible effects were related to stimulation duration and whether change in seizure frequency was associated with cognitive changes. Materials and methods Bilateral ANT electrodes were implanted in 18 patients with refractory epilepsy, aged 18–52 years. Immediately after implantation, patients were randomized to stimulation ON (n = 8) or OFF (n = 10) for the first 6 months (blinded phase). During the following 6‐month open phase, both groups received stimulation. Neuropsychological assessments were conducted before implantation (T1), at the end of the blinded period (T2), and 1 year after implantation (T3). Results Groupwise comparisons across the three time points revealed changes in performance in two of 22 cognitive test scores: motor speed and sustained attention. We found no significant group differences in cognitive change from T1 to T2. Patients reported fewer symptoms of executive dysfunction after 12 months of stimulation. Patients showing significant improvement in seizure frequency had better performance in a measure of verbal learning. Conclusion Our results indicate that ANT‐DBS has very limited effects on cognitive functioning, as measured by formal tests after 6‐ or 12‐month stimulation. ANT‐DBS may have a positive influence on executive function. Our findings provide limited support for an association between change in seizure frequency and cognitive functioning.

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Section: Discussionmentioning

confidence: 99%

Cognitive change after DBS in refractory epilepsy: A randomized‐controlled trial

Heminghyt

Herrman

Skogan

et al. 2021

Acta Neuro Scandinavica

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“…Multiple literature reviews of RCTs and case series regarding DBS for epilepsy show a steady increase in the use of DBS as a neurostimulation strategy and support its use for medically refractory epilepsy. [33][34][35][36][37][38][39] Previous systematic reviews have noted the lack of studies with direct comparisons between neurostimulation strategies. 40 Three rigorous systematic reviews of interest support the use of ANT DBS in medically refractory epilepsy.…”

Section: Systematic Reviewsmentioning

confidence: 99%

ASSFN Position Statement on Deep Brain Stimulation for Medication-Refractory Epilepsy

et al. 2022

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Neuromodulation has taken a foothold in the landscape of surgical treatment for medically refractory epilepsies and offers additional surgical treatment options for patients who are not candidates for resective/ablative surgery. Approximately one third of patients with epilepsy suffer with medication-refractory epilepsy. A persistent underuse of epilepsy surgery exists. Neuromodulation treatments including deep brain stimulation (DBS) expand the surgical options for patients with epilepsy and provide options for patients who are not candidates for resective surgery. DBS of the bilateral anterior nucleus of the thalamus is an Food and Drug Administration-approved, safe, and efficacious treatment option for patients with refractory focal epilepsy. The purpose of this consensus position statement is to summarize evidence, provide recommendations, and identify indications and populations for future investigation in DBS for epilepsy. The recommendations of the American Society of Functional and Stereotactic Neurosurgeons are based on several randomized and blinded clinical trials with high-quality data to support the use of DBS to the anterior nucleus of the thalamus for the treatment of refractory focal-onset seizures.

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“…Carbamazepine is the first choice for the treatment of partial seizures, partial systemic seizures, and mandatory seizures, followed by phenytoin sodium, phenobarbital, and valproic acid (22,23). Valproic acid is the first-choice treatment for systemic spasmodic seizures and spastic seizures, followed by carbamazepine, topiramate, and oxcarbazepine (24). The use of sodium valproate drug can cause blood cell reduction and liver function damage in patients, and long-term use may cause brain damage in patients (25).…”

Section: Introductionmentioning

confidence: 99%

The efficacy of lamotrigine after failure of the first administration of valproate in treating epilepsy: a systematic review and meta-analysis

He¹,

Wu²,

Dong³

2022

Ann Palliat Med

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Background: Epilepsy is a long-term recurrent chronic brain disease that can cause significant emotional burden to the patient and their family, as well as huge economic costs to society. Timely and accurate diagnosis of epilepsy, together with early and standardized treatments can effectively control seizures and restore the patient's quality of life and reduce the economic burden. This meta-analysis examined the efficacy of lamotrigine administration in patients with epilepsy.Methods: A literature search was performed in the PubMed, Embase, and OVID-Medline databases to identify articles related to epilepsy and lamotrigine that were published from the establishment of the database to April 2021. The keywords used for the literature search included "epilepsy", "sodium valproate", "lamotrigine", "effectiveness", and "therapeutic effect". It uses Cochrane review manual 5.3 to evaluate the quality of the included literature and review manager 5.3 software for meta-analysis.Results: A total of 9 studies involving 1,864 patients with epilepsy were included in this meta-analysis.The results revealed that, after treatment failure with the first drug of valproic acid, the total effective rate of lamotrigine treatment had an odds ratio (OR) of 2.21 with a 95% confidence interval (CI) of 1.15 to 4.27 (Z=2.37; P=0.02). The total adverse reaction rate (OR =0.70; 95% CI: 0.55 to 0.88; Z=2.98; P=0.003) and the improvement rate of epilepsy associated with lamotrigine treatment (OR =4.22; 95% CI: 1.00 to 17.84; Z=1.96; P=0.05) were all significantly higher than that of other drug treatments.Discussion: A total of 9 articles were included in this meta-analysis to examine the efficacy of lamotrigine in the treatment of epilepsy. The clinical efficacy of lamotrigine addition therapy was found to be superior to lamotrigine replacement therapy, and the incidence of adverse reactions was lower than that of lamotrigine replacement therapy. However, due to the low methodological quality of the included literatures, this conclusion should be further verified using large sample and high-quality randomized double-blinded experiments.

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Deep Brain Stimulation for Treatment of Refractory Epilepsy

Cited by 3 publications

References 79 publications

Cognitive change after DBS in refractory epilepsy: A randomized‐controlled trial

Cognitive change after DBS in refractory epilepsy: A randomized‐controlled trial

ASSFN Position Statement on Deep Brain Stimulation for Medication-Refractory Epilepsy

The efficacy of lamotrigine after failure of the first administration of valproate in treating epilepsy: a systematic review and meta-analysis

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