Similarities between the responses to <scp>ANT</scp>‐<scp>DBS</scp> and prior <scp>VNS</scp> in refractory epilepsy

Kulju, Toni; Haapasalo, Joonas; Kai, Li; Rainesalo, Sirpa; Peltola, Jukka

doi:10.1002/brb3.983

Cited by 27 publications

(27 citation statements)

References 16 publications

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“…Finally, the parameter space is vast in each device, and there are not yet methods of establishing optimal parameters. A trial-and-error approach is generally chosen, with parameters adjusted when seizures reoccur [123]. In the case of CSCS and other invasive brain stimulation, there must be special consideration of the location of cathodal and anodal contacts.…”

Section: Discussionmentioning

confidence: 99%

A Review of Neurostimulation for Epilepsy in Pediatrics

et al. 2019

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Neurostimulation for epilepsy refers to the application of electricity to affect the central nervous system, with the goal of reducing seizure frequency and severity. We review the available evidence for the use of neurostimulation to treat pediatric epilepsy, including vagus nerve stimulation (VNS), responsive neurostimulation (RNS), deep brain stimulation (DBS), chronic subthreshold cortical stimulation (CSCS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). We consider possible mechanisms of action and safety concerns, and we propose a methodology for selecting between available options. In general, we find neurostimulation is safe and effective, although any high quality evidence applying neurostimulation to pediatrics is lacking. Further research is needed to understand neuromodulatory systems, and to identify biomarkers of response in order to establish optimal stimulation paradigms.

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Section: Discussionmentioning

confidence: 99%

A Review of Neurostimulation for Epilepsy in Pediatrics

et al. 2019

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“…Although comparing the ANT-DBS-induced changes in cytokine levels to VNS-induced changes is not the primary aim of this study, existing reports of a VNS-induced reduction in systemic levels of the proinflammatory cytokines IL-6 and TNF-α and increased levels of the anti-inflammatory cytokines IL-10 and transforming growth factor beta (TGF-β) 19 , 21 are similar to those in our patients treated with DBS, indicating commonalities in the immunological response elicited by both VNS and DBS. We have previously suggested a putative association between the clinical responses to DBS and prior VNS in patients with DRE 34 .…”

Section: Discussionmentioning

confidence: 99%

A 1-year follow-up study on immunological changes following deep brain stimulation in patients with epilepsy

Basnyat

Järvenpää

Raitanen

et al. 2021

Sci Rep

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The aim of this study was to evaluate the effects of deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) on systemic inflammatory responses in patients with drug-resistant epilepsy (DRE). Twenty-two Finnish patients with ANT-DBS implantation were enrolled in this pilot study. Changes in plasma interleukin-6 (IL-6) and interleukin-10 (IL-10) levels were examined using generalized estimating equation models at seven time points (before DBS surgery and 1, 2, 3, 6, 9 and 12 months after implantation). In the whole group, the IL-6/IL-10 ratio decreased significantly over time following ANT-DBS, while the decrease in IL-6 levels and increase in IL-10 levels were not significant. In the responder and nonresponder groups, IL-6 levels remained unchanged during the follow-up. Responders had significantly lower pre-DBS IL-10 levels before the ANT-DBS treatment than nonresponders, but the levels significantly increased over time after the treatment. In addition, responders had a higher pre-DBS IL-6/IL-10 ratio than nonresponders, and the ratio decreased for both groups after treatment, but the decrease did not reach the level of statistical significance. The rate of decrease in the ratio per month tended to be higher in responders than in nonresponders. These results may highlight the anti-inflammatory properties of ANT-DBS treatment associated with its therapeutic effectiveness in patients with DRE. Additional studies are essential to evaluate the potential of the proinflammatory cytokine IL-6, the anti-inflammatory cytokine IL-10, and their ratio as biomarkers to evaluate the therapeutic response to DBS treatment, which could facilitate treatment optimization.

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“…Instead of allowing for the free transmission of the epileptic current, the DBS is programmed to transmit the artificial current in a preset cycle. In this way, some epileptic circuits could be blocked to prevent the seizure or to reduce the seizure frequency 120,122‐124 . In 2018, the FDA approved DBS of the ANT, namely ANT‐DBS for the treatment of drug‐resistant focal epilepsy patients (DRFE) when surgery or minimally invasive neuromodulation therapy is not possible or fails.…”

Section: Potential Alternative Therapies For Drug‐resistant Focal Epilepsymentioning

confidence: 99%

“…In 2018, the FDA approved DBS of the ANT, namely ANT‐DBS for the treatment of drug‐resistant focal epilepsy patients (DRFE) when surgery or minimally invasive neuromodulation therapy is not possible or fails. DBS is designed to cure certain forms of epilepsy (including drug resistance focal epilepsy) 123,125 . To determine whether a patient can benefit from DBS, a thorough evaluation should be conducted.…”

Section: Potential Alternative Therapies For Drug‐resistant Focal Epilepsymentioning

confidence: 99%

Potential surgical therapies for drug‐resistant focal epilepsy

et al. 2021

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Drug‐resistant focal epilepsy (DRFE), defined by failure of two antiepileptic drugs, affects 30% of epileptic patients. Epilepsy surgeries are alternative options for this population. Preoperative evaluation is critical to include potential candidates, and to choose the most appropriate procedure to maximize efficacy and simultaneously minimize side effects. Traditional procedures involve open skull surgeries and epileptic focus resection. Alternatively, neuromodulation surgeries use peripheral nerve or deep brain stimulation to reduce the activities of epileptogenic focus. With the advanced improvement of laser‐induced thermal therapy (LITT) technique and its utilization in neurosurgery, magnetic resonance‐guided LITT (MRgLITT) emerges as a minimal invasive approach for drug‐resistant focal epilepsy. In the present review, we first introduce drug‐resistant focal epilepsy and summarize the indications, pros and cons of traditional surgical procedures and neuromodulation procedures. And then, focusing on MRgLITT, we thoroughly discuss its history, its technical details, its safety issues, and current evidence on its clinical applications. A case report on MRgLITT is also included to illustrate the preoperational evaluation. We believe that MRgLITT is a promising approach in selected patients with drug‐resistant focal epilepsy, although large prospective studies are required to evaluate its efficacy and side effects, as well as to implement a standardized protocol for its application.

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Similarities between the responses to ANT‐DBS and prior VNS in refractory epilepsy

Cited by 27 publications

References 16 publications

A Review of Neurostimulation for Epilepsy in Pediatrics

A Review of Neurostimulation for Epilepsy in Pediatrics

A 1-year follow-up study on immunological changes following deep brain stimulation in patients with epilepsy

Potential surgical therapies for drug‐resistant focal epilepsy

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