Neurostimulation in the treatment of epilepsy

@article{Bergey2013NeurostimulationIT,
  title={Neurostimulation in the treatment of epilepsy},
  author={Gregory K. Bergey},
  journal={Experimental Neurology},
  year={2013},
  volume={244},
  pages={87-95}
}
  • G. Bergey
  • Published 1 June 2013
  • Medicine, Psychology
  • Experimental Neurology

Responsive Direct Brain Stimulation for Epilepsy.

Neuromodulation Therapy: Nonmedical, Nonsurgical Treatment for Intractable Epilepsy

TLDR
Neuromodulation therapy has been tried for patients with many neuropsychiatric disorders such as Parkinson’s disease, tremor, obcessive-compulsive disorder, depression, intractable pain, or addiction and it is shown that focal electrical cortical stimulation could stop both normal EEG rhythms and spontaneous epileptiform discharges.

The RNS System: brain-responsive neurostimulation for the treatment of epilepsy

TLDR
Combining advanced machine learning approaches with the chronic ambulatory brain data collected by the RNS System could eventually enable automatic fine-tuning of detection and stimulation for each patient, creating a general-purpose neurotechnological platform for precision medicine.

Closed-loop Neurostimulation: The Clinical Experience

TLDR
This review focuses on the clinical experience of four implantable closed-loop neurostimulation systems: positional-adaptive spinal cord stimulation for treatment of pain, responsive cortical stimulation for treating epilepsy, closed- loop vagus nerve stimulation for Treatment of epilepsy, and concurrent sensing and stimulation fortreatment of Parkinson disease.

Deep Brain Stimulation and Drug-Resistant Epilepsy: A Review of the Literature

TLDR
This article presents the use of stimulation of the anterior and centromedian nucleus of the thalamus, hippocampus, basal ganglia, cerebellum and hypothalamus, and anterior thalamic nucleus stimulation for the treatment of drug-resistant epilepsy.

Vagus Nerve Stimulation and Other Neuromodulation

TLDR
This chapter will review the historical aspects, indications, technical aspects, major clinical trials, managing stimulus parameters (programming), and safety and precautions in handling patients treated with VNS.

Investigational Treatments for Status Epileptics

TLDR
This chapter focuses on antiseizure medications in clinical trials, the somewhat more remote prospect of gene therapy, and transcranial magnetic stimulation.

Between the Pulse Generator and the Anterior Thalamic Nucleus: The Light at the End of the Tunnel

TLDR
The results of a longterm follow-up of safety and efficacy of the SANTE trial beginning at 13 months after device implantation and continuing for 4 years provided Class IV evidence that ANT stimulation was associated with a 69% reduction in seizures and a 34% serious device-related adverse event rate at 5 years.

The Role of Anterior Thalamic Deep Brain Stimulation as an Alternative Therapy in Patients with Previously Failed Vagus Nerve Stimulation for Refractory Epilepsy

TLDR
This is the first study in which favorable outcomes of ANT-DBS surgery were observed in individual patients with refractory epilepsy who had not responded to prior VNS, and 1 responder reached a seizure-free status after DBS therapy.

Management of refractory epilepsy.

  • K. Muñana
  • Psychology, Medicine
    Topics in companion animal medicine
  • 2013
TLDR
The 2 alternative forms of therapy that have shown the most promise in humans with epilepsy are electrical stimulation of the brain and dietary modification, both of which have also been evaluated in dogs.
...

References

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Transcranial Magnetic Stimulation for Drug-Resistant Epilepsies: Rationale and Clinical Experience

TLDR
It is concluded that, although the therapeutic effects of repetitive TMS in epilepsy appear rather limited, further clinical testing of this rapidly evolving technology is warranted.

Neurostimulation therapies for treatment resistant depression: A focus on vagus nerve stimulation and deep brain stimulation

TLDR
VNS and deep brain stimulation are neurostimulation treatments for TRD and the evidence supporting the clinical utility of these therapies is reviewed.

Deep brain stimulation in epilepsy with particular reference to the subthalamic nucleus.

Alternative methods, for the treatment of medically refractory epileptic patients, who cannot be treated by resective surgery, such as chronic deep brain neurostimulation, are under development. Such

Responsive cortical stimulation for the treatment of medically intractable partial epilepsy

TLDR
This study provides Class I evidence that responsive cortical stimulation is effective in significantly reducing seizure frequency for 12 weeks in adults who have failed 2 or more antiepileptic medication trials, 3 or more seizures per month, and 1 or 2 seizure foci.

TRIGEMINAL NERVE STIMULATION FOR EPILEPSY: LONG-TERM FEASIBILITY AND EFFICACY

TLDR
The long-term safety and efficacy of external TNS for epilepsy, a novel form of neurostimulation that has an antiepileptic effect in a rodent model, is reported.

A double-blind trial of chronic cerebellar stimulation in twelve patients with severe epilepsy.

TLDR
Cerebellar stimulation in its present form cannot be recommended for the treatment of severe intractable epilepsy, though eleven of the patients considered that the trial had helped them.

Randomized controlled trial of trigeminal nerve stimulation for drug-resistant epilepsy

TLDR
This phase II study provides Class II evidence that trigeminal nerve stimulation may be safe and effective in reducing seizures in people with DRE and will serve as a basis to inform and power a larger multicenter phase III clinical trial.

Placebo‐Controlled Pilot Study of Centromedian Thalamic Stimulation in Treatment of Intractable Seizures

TLDR
This pilot project demonstrated the feasibility of controlled study of thalamic stimulation in epilepsy, but further study will be needed to demonstrate efficacy.
...