Neurostimulation in people with drug‐resistant epilepsy: Systematic review and meta‐analysis from the ILAE Surgical Therapies Commission

Touma, Lahoud; Dansereau, Bénédicte; Chan, Alvin Y.; Kwon, Churl‐Su; Braun, Kees P.J.; Friedman, Daniel J.; Jehi, Lara; Rolston, John D.; Vadera, Sumeet; Wong‐Kisiel, Lily C.; Englot, Dario J.; Keezer, Mark R

doi:10.1111/epi.17243

Cited by 56 publications

(46 citation statements)

References 68 publications

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“…Whilst there have been recent reviews that have summarized the current availability and efficacy of intracranial neurostimulation therapies for epilepsy, 14–16 , 27 , 28 we here approach these therapies from a network neuroscience perspective. A network-guided neuromodulation framework for epilepsy allows us to ask questions that may advance the treatment options and efficacy that we can offer to patients.…”

Section: Introductionmentioning

confidence: 99%

Towards network-guided neuromodulation for epilepsy

Piper

Richardson

Worrell

et al. 2022

Brain

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Epilepsy is well-recognized as a disorder of brain networks. There is a growing body of research to identify critical nodes within dynamic epileptic networks with the aim to target therapies that halt the onset and propagation of seizures. In parallel, intracranial neuromodulation, including deep brain stimulation and responsive neurostimulation, are well-established and expanding as therapies to reduce seizures in adults with focal epilepsy; and there is emerging evidence for their efficacy in children and generalized seizure disorders. The convergence of these advancing fields is driving an era of ‘network-guided neuromodulation’ for epilepsy. In this review we distil the current literature on network mechanisms underlying neurostimulation for epilepsy. We discuss the modulation of key propagation points in the epileptogenic network, focusing primarily on thalamic nuclei targeted in current clinical practice. These include (a) the anterior nucleus of thalamus, now a clinically approved and targeted site for open loop stimulation, and increasingly targeted for responsive neurostimulation; and (b) the centromedian nucleus of the thalamus, a target for both deep brain stimulation and responsive neurostimulation in generalized-onset epilepsies. We discuss briefly the networks associated with other emerging neuromodulation targets, such as the pulvinar of the thalamus, piriform cortex, septal area, subthalamic nucleus, cerebellum and others. We report synergistic findings garnered from multiple modalities of investigation that revealed structural and functional networks associated with these propagation points – including scalp and invasive electroencephalography, diffusion and functional magnetic resonance imaging. We also report on intracranial recordings from implanted devices which provide us data on the dynamic networks we are aiming to modulate. Finally, we review the continuing evolution of network-guided neurostimulation for epilepsy to accelerate progress towards two major goals: (1) to use pre-surgical network analyses to determine patient candidacy for neurostimulation for epilepsy by providing network biomarkers that predict efficacy; and (2) to deliver precise, personalized and effective antiepileptic stimulation to prevent and arrest seizures, limit seizure propagation through mapping and modulation of each patients’ individual epileptogenic networks.

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Section: Introductionmentioning

confidence: 99%

Towards network-guided neuromodulation for epilepsy

Piper

Richardson

Worrell

et al. 2022

Brain

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“…Although head‐to‐head comparison studies are sparse, meta‐analytic approaches have attempted to synthesize available evidence and compare the modalities. A recent report by the ILAE surgical therapies commission failed to show a relative superiority of one of the available neurostimulation modalities 41 . The ILAE report includes all types of epilepsy and included the pivotal trial studies for VNS, RNS and DBS; select case series were also included for VNS.…”

Section: Discussionmentioning

confidence: 99%

“…A recent report by the ILAE surgical therapies commission failed to show a relative superiority of one of the available neurostimulation modalities. 41 The ILAE report includes all types of epilepsy and included the pivotal trial studies for VNS, RNS and DBS; select case F I G U R E 2 Forest plots showing pooled seizure reduction for vagus nerve stimulation (VNS) and deep brain stimulation (DBS). Most VNS outcomes were inferior to the overall mean (left of vertical dotted lines), whereas most DBS outcomes were superior to the mean.…”

Section: Clinical Equipoise In Neurostimulation Device Choicementioning

confidence: 99%

Neurostimulation in generalized epilepsy: A systematic review and meta‐analysis

Haneef

Skrehot

2023

Epilepsia

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Objective: There are three neurostimulation devices available to treat generalized epilepsy: vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS). However, the choice between them is unclear due to lack of head-to-head comparisons. A systematic comparison of neurostimulation outcomes in generalized epilepsy has not been performed previously. The goal of this meta-analysis was to determine whether one of these devices is better than the others to treat generalized epilepsy.Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review of PubMed, Embase, and Web How to cite this article: Haneef Z, Skrehot HC. Neurostimulation in generalized epilepsy: A systematic review and meta-analysis. Epilepsia.

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“…1 But in focal epilepsy, more data support the long-term efficacy of brain stimulation compared to VNS, as recently described in a systematic review by the ILAE Surgical Therapies Commission. 2 This leads to an important question: can novel brain stimulation therapies break the barrier to surgical treatment of primary generalized epilepsies?…”

Section: Commentarymentioning

confidence: 99%