Therapeutic Brain Stimulation for Epilepsy
Section snippets
History
Brain stimulation in people with epilepsy was first explored in the 1940s and 50s by Penfield and Jasper using intraoperative stimulation to map seizure foci in relation to eloquent regions of cortex. Depth electrodes to record epileptiform activity from deep structures became popular after the pioneering works of Bancaud and Talairach.1 These uses of stimulation were diagnostic.
The first use of electrical stimulation to influence seizures or behavior in people with epilepsy probably was by
Stimulation sites
A variety of anatomic sites have been targeted for brain stimulation in patients with epilepsy and in laboratory models of epilepsy. In this article, the authors focus on the human studies, but reference may be made to Krauss and Fisher5 for reviews of early studies in animal models. Clinically based literature consists mainly of case reports with rare randomized controlled trials, making efficacy unclear in many studies. The effect of stimulation is often unable to be investigated
Complications
Much of what is known regarding complications of DBS comes from experience in the treatment of movement disorders. Hardware-related complications, such as infection, paresthesias, and broken leads, are most common. Other adverse events include intracranial hemorrhage, cognitive impairment, and worsening of seizures.
Hamani and Lozano44 reviewed 254 articles on DBS and identified 10 that principally explored complications. A total of 922 patients were reported to have difficulties, including
Mechanisms of deep brain stimulation
Several hypotheses have been proposed for the mechanism behind DBS for epilepsy, although research remains limited. Data thus far support mechanisms of disruption at the level of individual neurons, synapses (in the form of increased inhibitory or decreased excitatory potentials), and neuronal networks. The behavior of a neuron in response to stimulation may be somewhat predictable, as estimated by such inherent properties as orientation, membrane resistance, and conductance. However, the
Responsive devices
Vagus nerve stimulation and the previously discussed SANTE trial of the anterior thalamus use stimulation on a timed schedule. Another strategy is to record ongoing EEG and to stimulate in response to a detected correlate of seizure activity—this is called responsive neurostimulation (RNS). Stimulation on schedule is also called “open-loop,” to distinguish it from “closed-loop” RNS, which uses a feedback loop. An example of a closed-loop device is the automated cardiac defibrillator. Advances
Summary
DBS has been a possible therapy for epilepsy for more than 30 years, and now it is moving to the point of clinical utility. Animal models have shown efficacy of DBS at several brain regions, although not all animal studies have shown efficacy. Clinically, an array of sites have been explored, including the cerebellum, anterior nucleus of the thalamus, CM nucleus, hippocampus, subthalamic nucleus, brainstem, and corpus callosum; direct stimulation of the cortex has also been explored. Interest
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Cited by (37)
Kindling in humans: Does secondary epileptogenesis occur?
2023, Epilepsy ResearchNon-invasive transcranial brain modulation for neurological disorders treatment: A narrative review
2022, Life SciencesCitation Excerpt :Moreover, antiepileptic medicines (AEDs) are not suitable for about a third of individuals with epilepsy [119]. Therefore, the use of TES to treat intractable epilepsy becoming more common [120]. In drug-resistant individuals, closed-loop tECS can be a helpful treatment tool for reducing abnormal brain patterns [121].
Deep brain stimulation of the anterior thalamus attenuates PTZ kindling with concomitant reduction of adenosine kinase expression in rats
2022, Brain StimulationCitation Excerpt :One such alternative treatment is deep brain stimulation (DBS) [7]. DBS is based on the delivery of an electrical stimulus to the brain parenchyma via implanted electrodes and has been increasingly used for the clinical treatment of epilepsy [8,9], movement disorders [10,11], and psychiatric disorders [12,13]. More recently, DBS of the anterior nucleus of the thalamus (ANT) specifically has been approved for the treatment of refractory epilepsy [14].
The antiepileptogenic effect of low-frequency stimulation on perforant path kindling involves changes in regulators of G-protein signaling in rat
2017, Journal of the Neurological SciencesCitation Excerpt :Deep brain stimulation (DBS) has been considered a possible therapy for epilepsy for > 30 years. Recently, DBS has been approved by the U.S. Food and Drug Administration (FDA) [2], and now DBS is moving to the point of clinical utility, especially for drug-resistant epilepsies [18,19,40,42,43,47]. Mounting evidence shows that the application of deep brain stimulation in the form of low-frequency electrical stimulation (LFS) has therapeutic effects in both epileptic patients [3,35] and experimental models of epilepsy, including kindling [25,57,66].
Consecutive 15 min is necessary for focal low frequency stimulation to inhibit amygdaloid-kindling seizures in rats
2013, Epilepsy ResearchCitation Excerpt :So another possible mechanism is that LFS-1MIN and LFS-5 min in our experiment are not long enough to induce LTD, which leaded to the invalid anti-epileptic result. Intermittent stimulation is common in high frequency stimulation (HFS) (Liang et al., 2011; Lockman and Fisher, 2009), which can avoid the abnormal behavior and neural injury induced by HFS with long stimulation duration. Very few studies have analyzed the effects of consecutive or intermittent LFS on seizure activity using a defined set of parameters.
Anesthetic Considerations for Awake Craniotomy for Epilepsy and Functional Neurosurgery
2012, Anesthesiology Clinics
The senior author, Robert S. Fisher, was supported by the James and Carrie Anderson Fund for Epilepsy Research, the Susan Horngren Fund, and the Littlefield-DeFreyne Fund. He holds the Maslah Saul, MD Chair.