Transcranial direct current stimulation for focal status epilepticus or lateralized periodic discharges in four patients in a critical care setting

Abstract

Objective: Transcranial direct current stimulation (tDCS) has been advocated for various neurological conditions, including epilepsy. A 1-4-mA cathodal current applied to the scalp over a seizure focus can reduce spikes and seizures. This series of four patients with focal status epilepticus is among the first case series to demonstrate benefit of tDCS in the critical care setting.Methods: Patients in the intensive care unit were referred for tDCS treatment when focal status epilepticus or clinically relevant lateralized periodic discharges did not resolve with conventional antiseizure medications and anesthetics.Battery-powered direct cathodal current at 2 mA was delivered by an ActivaDose (Caputron) tDCS device via a saline-soaked sponge on the scalp over the seizure focus. Anode was on the contralateral forehead or shoulder. Treatment was for 30 min, repeated twice in a day, then again 1-4 times more over the next few days.

Therapeutic Strategies to Ameliorate Neuronal Damage in Epilepsy by Regulating Oxidative Stress, Mitochondrial Dysfunction, and Neuroinflammation

“…Invasive methods include VNS, deep brain stimulation, which uses implanted electrodes, and responsive neurostimulation, which is activated when a seizure is detected [264][265][266][267][268]. Less-invasive treatment options include transcutaneous VNS, transcranial direct current stimulation, and trigeminal nerve stimulation [269][270][271][272][273][274][275]. As a whole, neuromodulation strategies can induce a 30%-40% decrease in seizure occurrence after 3 months of treatment [258].…”