Electrical brain stimulation for epilepsy

Abstract

Neurostimulation enables adjustable and reversible modulation of disease symptoms, including those of epilepsy. Two types of brain neuromodulation, comprising anterior thalamic deep brain stimulation and responsive neurostimulation at seizure foci, are supported by Class I evidence of effectiveness, and many other sites in the brain have been targeted in small trials of neurostimulation therapy for seizures. Animal studies have mainly assisted in the identification of potential neurostimulation sites and parameters, but much of the clinical work is only loosely based on fundamental principles derived from the laboratory, and the mechanisms by which brain neurostimulation reduces seizures remain poorly understood. The benefits of stimulation tend to increase over time, with maximal effect seen typically 1-2 years after implantation. Typical reductions of seizure frequency are approximately 40% acutely, and 50-69% after several years. Seizure intensity might also be reduced. Complications from brain neurostimulation are mainly associated with the implantation procedure and hardware, including stimulation-related paraesthesias, stimulation-site infections, electrode mistargeting and, in some patients, triggered seizures or even status epilepticus. Further preclinical and clinical experience with brain stimulation surgery should lead to improved outcomes by increasing our understanding of the optimal surgical candidates, sites and parameters.

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

“…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].…”

Computational modeling of neurostimulation in brain diseases

“…In the search for alternative treatments, brain stimulation has recently demonstrated some degree of success (Fisher and Velasco, 2014) in controlling seizures. In addition to established vagus nerve stimulation, recently anterior thalamic DBS and stimulation of the seizure focus in focal seizures have been demonstrated to be good approaches.…”

The Promising Role of Neuromodulation in Improving Ischemic Stroke Recovery

“…Invasive mechanisms of neuromodulation are aimed at accessing deeper brain structures and involves the surgical implantation of electrodes in close proximity to the tissue which is to be modulated, which are then coupled with neurostimulators that can be programmed to manage the activity of the electrodes [28][29]. These neurostimulators, implantable pulse generators, can then be accessed by physicians to make certain adjustments to the treatment, such as the amplitude, frequency, and pulse width that the electrodes generate [30].…”