Emerging approaches in neurostimulation for epilepsy

Abstract

Purpose of reviewNeurostimulation is a quickly growing treatment approach for epilepsy patients. We summarize recent approaches to provide a perspective on the future of neurostimulation.Recent findingsInvasive stimulation for treatment of focal epilepsy includes vagus nerve stimulation, responsive neurostimulation of the cortex and deep brain stimulation of the anterior nucleus of the thalamus. A wide range of other targets have been considered, including centromedian, central lateral and pulvinar thalamic nuclei; medial septum, nucleus accumbens, subthalamic nucleus, cerebellum, fornicodorsocommissure and piriform cortex. Stimulation for generalized onset seizures and mixed epilepsies as well as increased efforts focusing on paediatric populations have emerged. Hardware with more permanently implanted lead options and sensing capabilities is emerging. A wider variety of programming approaches than typically used may improve patient outcomes. Finally, noninvasive brain stimulation with its favourable risk profile offers the potential to treat increasingly diverse epilepsy patients.SummaryNeurostimulation for the treatment of epilepsy is surprisingly varied. Flexibility and reversibility of neurostimulation allows for rapid innovation. There remains a continued need for excitability biomarkers to guide treatment and innovation. Neurostimulation, a part of bioelectronic medicine, offers distinctive benefits as well as unique challenges.

Trends in the Utilization of Surgical Modalities for the Treatment of Drug-Resistant Epilepsy: A Comprehensive 10-Year Analysis Using the National Inpatient Sample

“…22,24 In patients receiving RNS, the complication profile included surgical site infections which rarely led to device explantations or permanent neurologic consequences. 25-28 Similar results were also found in patients receiving VNS, where the total complication risk amounted to 3.7% with most being infections, hematomas, and vocal cord palsies. 29 In patients who underwent open resection, as determined by a nationwide study on over 6000 patients, a 30-day mortality rate of 3.4% and a complication rate of 17.9% were recorded.…”

The Utility of Responsive Neurostimulation for the Treatment of Pediatric Drug-Resistant Epilepsy

“…Neuromodulation strategies vary based on the patient seizure type and frequency, including those that target the SOZ and those that target neural networks associated with seizure propagation [16][17][18]. There are currently three types of devices: vagus nerve stimulation (VNS), deep brain stimulation (DBS), and RNS [19,20].…”

Evaluation of Pharmacology and Pathophysiology Knowledge of Epilepsy among Senior Pharmacy Students: A Single Center Experience

“…While subcortical areas are less studied and understood than the cortex in epilepsy, recent research has shown that they may play a more significant role in some types of epilepsy than previously thought [ 9 ]. For example, some types of focal epilepsy, which originate in a specific area of the brain, may involve subcortical structures in addition to the cortex [ 10 ]. According to the focus and spread of discharges, unprovoked recurrent epileptic seizures may be classified as generalized, focal, and epileptic spasms [ 11 ].…”