Deep brain and cortical stimulation for epilepsy

Sprengers, Mathieu; Vonck, Kristl; Carrette, Evelien; Marson, Anthony G; Boon, Paul

doi:10.1002/14651858.cd008497.pub2

Cited by 70 publications

(78 citation statements)

References 58 publications

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“…European Conformity marking) and U.S. Food and Drug Administration (FDA) approval for refractory epilepsy, respectively. 155 Transcutaneous and noninvasive VNS (tVNS, nVNS), trigeminal nerve stimulation (TNS), transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS) are investigational noninvasive neurostimulation modalities. Their mechanisms of action, optimal stimulation parameters, and candidate selection criteria are currently uncertain.…”

Section: Neurostimulationmentioning

confidence: 99%

Diagnostic methods and treatment options for focal cortical dysplasia

et al. 2015

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SUMMARYOur inability to adequately treat many patients with refractory epilepsy caused by focal cortical dysplasia (FCD), surgical inaccessibility and failures are significant clinical drawbacks. The targeting of physiologic features of epileptogenesis in FCD and colocalizing functionality has enhanced completeness of surgical resection, the main determinant of outcome. Electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) and magnetoencephalography are helpful in guiding electrode implantation and surgical treatment, and high-frequency oscillations help defining the extent of the epileptogenic dysplasia. Ultra high-field MRI has a role in understanding the laminar organization of the cortex, and fluorodeoxyglucose-positron emission tomography (FDG-PET) is highly sensitive for detecting FCD in MRI-negative cases. Multimodal imaging is clinically valuable, either by improving the rate of postoperative seizure freedom or by reducing postoperative deficits. However, there is no level 1 evidence that it improves outcomes. Proof for a specific effect of antiepileptic drugs (AEDs) in FCD is lacking. Pathogenic mutations recently described in mammalian target of rapamycin (mTOR) genes in FCD have yielded important insights into novel treatment options with mTOR inhibitors, which might represent an example of personalized treatment of epilepsy based on the known mechanisms of disease. The ketogenic diet (KD) has been demonstrated to be particularly effective in children with epilepsy caused by structural abnormalities, especially FCD. It attenuates epigenetic chromatin modifications, a master regulator for gene expression and functional adaptation of the cell, thereby modifying disease progression. This could imply lasting benefit of dietary manipulation. Neurostimulation techniques have produced variable clinical outcomes in FCD. In widespread dysplasias, vagus nerve stimulation (VNS) has achieved responder rates >50%; however, the efficacy of noninvasive cranial nerve stimulation modalities such as transcutaneous VNS (tVNS) and noninvasive (nVNS) requires further study. Although review of current strategies underscores the serious shortcomings of treatment-resistant cases, initial evidence from novel approaches suggests that future success is possible.

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Section: Neurostimulationmentioning

confidence: 99%

Diagnostic methods and treatment options for focal cortical dysplasia

et al. 2015

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“…37 A recent Cochrane review notes that the sudden unexpected death in epilepsy (SUDEP) rate with RNS needs to be monitored carefully because the rate (11.8 per 1,000 patient-years) was higher than that seen in the literature for refractory epilepsy (2.2-10 per 1,000 patient-years). 38 In a similar Cochrane review for dietary treatments, there were no reports of SUDEP as an adverse effect. 39 RNS is currently available only to adult patients with focal onset epilepsy, only a limited number of epilepsy centers in the United States offer it, few neurosurgeons are familiar with implantation of the device, few epilepsy experts are trained in titrating treatment, and it is not yet available internationally.…”

Section: Responsive Neurostimulation (Rns)mentioning

confidence: 99%

Dietary therapy is the best option for refractory nonsurgical epilepsy

Felton

Cervenka

2015

Epilepsia

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Summary Ketogenic diet therapies for epilepsy have been described since the fifth century and published in scientific literature since the early 1900s. Since that time, the diet's popularity has waxed and waned as newer drugs and other treatments have been introduced. However, in recent years, dietary therapy for epilepsy has been increasingly accepted by physicians and desired by patients as an alternative to new drugs and neurostimulation. The introduction of less restrictive versions of the classic ketogenic diet, such as the modified Atkins diet (MAD), have led to increased numbers of adult patients with refractory epilepsy who are initiating dietary treatment. Approximately half of adults and children who start a ketogenic diet have a >50% seizure reduction, which is impressive given that these patients typically have medically refractory epilepsy. We believe that ketogenic dietary treatment is the best option for children and adults with refractory nonsurgical epilepsy due to its efficacy, rapid seizure reduction, synergistic effects with other antiseizure treatments, known and treatable side effects, potential to treat comorbid medical conditions, and worldwide availability.

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“…It has been generally accepted that a transient implant effect becomes evident within 4-8 weeks after electrode implantation. 2,11 Here, the 5-month delay of NAC stimulation argues for an anti-ictal effect of the electrical stimulation rather than being a consequence of electrode insertion.…”

Section: Discussionmentioning

confidence: 92%

“…1 For these patients, neuromodulative treatment strategies may be promising. 2 First results of randomized controlled trials have demonstrated efficacy of anterior thalamic nucleus (ANT) stimulation, especially in patients with complex partial seizures and temporal lobe epilepsy. 3 Based on the data of this study, the approval of ANT stimulation in patients with refractory partial epilepsy has been granted by the European regulatory authorities.…”

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confidence: 99%

Nucleus accumbens stimulation in partial epilepsy—A randomized controlled case series

et al. 2015

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Summary Neuromodulative treatment options are warranted in patients with difficult‐to‐treat epilepsy. However, acquisition of controlled data on deep brain stimulation has so far been achieved only for the centromedian and anterior thalamic nucleus. In a case series of four patients with intractable partial epilepsy, a randomized controlled cross‐over protocol was used to get insight into efficacy and safety of 3‐month nucleus accumbens stimulation. Seizure frequency, neurocognitive testing, “Liverpool Seizure Severity Score,” “Quality of Life in Epilepsy Inventory,” “Beck Depression Inventory,” and “Mini International Neuropsychiatric Interview” were obtained at every visit. In a subsequent open‐label phase, nucleus accumbens stimulation responders underwent concomitant anterior thalamic nucleus stimulation, whereas nonresponders received solely thalamic stimulation. Under nucleus accumbens stimulation, three of four patients had ≥50% reduction in frequency of disabling seizures without further improvement with additional anterior thalamic nucleus stimulation. Patient‐reported outcome and neurocognitive testing remained unchanged. Accumbens stimulation is safe and seems to be a suitable option in intractable partial epilepsy. The current findings require substantiation by an adequately powered multicenter study.

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Deep brain and cortical stimulation for epilepsy

Cited by 70 publications

References 58 publications

Diagnostic methods and treatment options for focal cortical dysplasia

Diagnostic methods and treatment options for focal cortical dysplasia

Dietary therapy is the best option for refractory nonsurgical epilepsy

Nucleus accumbens stimulation in partial epilepsy—A randomized controlled case series

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