Experimental electrical stimulation therapy for epilepsy

Oommen, Joseph; Morrell, Martha J.; Fisher, Robert S.

doi:10.1007/s11940-005-0036-9

Cited by 22 publications

(11 citation statements)

References 49 publications

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“…Electrical stimulation of the vagus nerve is clinically approved and has been used to treat drug‐resistant epilepsy and depression [105–107] and only relatively minor effects have been reported [106]. Unlike administration of cholinergic agonists, stimulation of the vagus nerve might be a more precise therapeutic approach to regulate inflammatory disease because it offers an amenable technique that takes advantage of the anatomical distribution of nerve fibres to reach specific organs and cell targets.…”

Section: Discussionmentioning

confidence: 99%

Cholinergic control of inflammation

Rosas-Ballina¹,

Tracey

2009

Journal of Internal Medicine

483

347

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Cytokine production is necessary to protect against pathogens and promote tissue repair, but excessive cytokine release can lead to systemic inflammation, organ failure and death. Inflammatory responses are finely regulated to effectively guard from noxious stimuli. The central nervous system interacts dynamically with the immune system to modulate inflammation through humoral and neural pathways. The effect of glucocorticoids and other humoral mediators on inflammatory responses has been studied extensively in the past decades. In contrast, neural control of inflammation has only been recently described. We summarize autonomic regulation of local and systemic inflammation through the ‘cholinergic anti-inflammatory pathway’, a mechanism consisting of the vagus nerve and its major neurotransmitter, acetylcholine, a process dependent on the nicotinic acetylcholine receptor α7 subunit. We recapitulate additional sources of acetylcholine and their contribution to the inflammatory response, as well as acetylcholine regulation by acetylcholinesterase as a means to attenuate inflammation. We discuss potential therapeutic applications to treat diseases characterized by acute or chronic inflammation, including autoimmune diseases, and propose future research directions.

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Section: Discussionmentioning

confidence: 99%

Cholinergic control of inflammation

Rosas-Ballina¹,

Tracey

2009

Journal of Internal Medicine

483

347

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“…32 These standards are a breakthrough for patient care and safety. The recent clinical studies involving stimulation devices have been carefully controlled and designed, with patient safety and measurable outcomes as primary goals, 33 and the era of controlled trials in epileptic devices is now underway in earnest. 34 Vagus nerve stimulation-The Vagus Nerve Stimulator (VNS, Cyberonics, Inc., Houston, TX, USA) is the first FDA-approved device for treating epilepsy.…”

Section: Open-loop Devices To Treat Seizures-mentioning

confidence: 99%

Technology Insight: neuroengineering and epilepsy—designing devices for seizure control

2008

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Despite substantial innovations in antiepileptic drug therapy over the past 15 years, the proportion of patients with uncontrolled epilepsy has not changed, highlighting the need for new treatment strategies. New implantable antiepileptic devices, which are currently under development and in pivotal clinical trials, hold great promise for improving the quality of life of millions of people with epileptic seizures worldwide. A broad range of strategies to stop seizures is currently being investigated, with various modes of control and intervention. The success of novel antiepileptic devices rests upon collaboration between neuroengineers, physicians and industry to adapt new technologies for clinical use. The initial results with these technologies are exciting, but considerable development and controlled clinical trials will be required before these treatments earn a place in our standard of clinical care.

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“…Building on these initial experiments, numerous studies have been published over the last three decades that examine the safety and efficacy of open-loop and closed-loop, focal and non-focal electrical stimulation for the treatment of epilepsy. [7][8][9] In the first chronic brain stimulation trials for epilepsy, electrical stimulation was delivered in an open-loop manner; that is, therapy was delivered according to a predefined schedule, independent of physiological activity. These studies targeted deep brain structures remote to the epileptic focus, such as the cerebellum, thalamus, and basal ganglia.…”

Section: Introductionmentioning

confidence: 99%

Responsive Cortical Stimulation for the Treatment of Epilepsy

2008

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Summary: Epilepsy is a common chronic neurological disorder affecting ϳ1-2% of the population. Despite the available treatment options (pharmacotherapy, surgery, and vagus nerve stimulation), a large percentage of patients continue to have seizures. With the success of deep brain stimulation for treatment of movement disorders, brain stimulation has received renewed attention as a potential treatment option for epilepsy.Responsive stimulation aims to suppress epileptiform activity by delivering stimulation directly in response to electrographic activity. Animal and human data support the concept that responsive stimulation can abort epileptiform activity, and this modality may be a safe and effective treatment option for epilepsy. Responsive stimulation has the advantage of specificity. In contrast to the typically systemic administration of pharmacotherapy, with the concomitant possibility of side effects, electrical stimulation can be targeted to the specific brain regions involved in the seizure. In addition, responsive stimulation provides temporal specificity. Treatment is provided as needed, potentially reducing the likelihood of functional disruption or habituation due to continuous treatment. Here we review current animal and human research in responsive brain stimulation for epilepsy and then discuss the NeuroPace RNS System, an investigational implantable responsive neurostimulator system that is being evaluated in a multicenter, randomized, double-blinded trial to assess the safety and efficacy of responsive stimulation for the treatment of medically refractory epilepsy.

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Experimental electrical stimulation therapy for epilepsy

Cited by 22 publications

References 49 publications

Cholinergic control of inflammation

Cholinergic control of inflammation

Technology Insight: neuroengineering and epilepsy—designing devices for seizure control

Responsive Cortical Stimulation for the Treatment of Epilepsy

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