Key Points
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Electrical brain stimulation is an increasingly utilized therapy for medication-resistant seizures
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Randomized controlled trials have demonstrated the efficacy and safety of intermittent (on a clock cycle) thalamic deep brain stimulation, and responsive neurostimulation at the site(s) of seizure origin
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Stimulation to control seizures has been investigated in brain regions including the cerebellum, centromedian thalamus, hippocampus, anterior nucleus of the thalamus, motor cortex, caudate, subthalamic nucleus, and other seizure foci
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Despite several laboratory studies, the mechanisms by which electrical brain stimulation ameliorates epilepsy remain poorly understood
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Additional experience will be needed to individualize neurostimulation therapy for patients with drug-resistant seizures, determine which type of neurostimulation to first employ, and decide when to intervene
Abstract
Neurostimulation enables adjustable and reversible modulation of disease symptoms, including those of epilepsy. Two types of brain neuromodulation, comprising anterior thalamic deep brain stimulation and responsive neurostimulation at seizure foci, are supported by Class I evidence of effectiveness, and many other sites in the brain have been targeted in small trials of neurostimulation therapy for seizures. Animal studies have mainly assisted in the identification of potential neurostimulation sites and parameters, but much of the clinical work is only loosely based on fundamental principles derived from the laboratory, and the mechanisms by which brain neurostimulation reduces seizures remain poorly understood. The benefits of stimulation tend to increase over time, with maximal effect seen typically 1–2 years after implantation. Typical reductions of seizure frequency are approximately 40% acutely, and 50–69% after several years. Seizure intensity might also be reduced. Complications from brain neurostimulation are mainly associated with the implantation procedure and hardware, including stimulation-related paraesthesias, stimulation-site infections, electrode mistargeting and, in some patients, triggered seizures or even status epilepticus. Further preclinical and clinical experience with brain stimulation surgery should lead to improved outcomes by increasing our understanding of the optimal surgical candidates, sites and parameters.
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References
Heath, R. G. Electrical self-stimulation of the brain in man. Am. J. Psychiatry 120, 571–577 (1963).
Delgado, J. M., Hamlin, H. & Chapman, W. P. Technique of intracranial electrode implacement for recording and stimulation and its possible therapeutic value in psychotic patients. Confin. Neurol. 12, 315–319 (1952).
Cooper, I. S., Amin, I. & Gilman, S. The effect of chronic cerebellar stimulation upon epilepsy in man. Trans. Am. Neurol. Assoc. 98, 192–196 (1973).
Cooper, I. S. & Upton, A. R. Therapeutic implications of modulation of metabolism and functional activity of cerebral cortex by chronic stimulation of cerebellum and thalamus. Biol. Psychiatry 20, 811–813 (1985).
Cooper, I. S., Upton, A. R. & Amin, I. Reversibility of chronic neurologic deficits. Some effects of electrical stimulation of the thalamus and internal capsule in man. Appl. Neurophysiol. 43, 244–258 (1980).
Upton, A. R., Cooper, I. S., Springman, M. & Amin, I. Suppression of seizures and psychosis of limbic system origin by chronic stimulation of anterior nucleus of the thalamus. Int. J. Neurol. 19–20, 223–230 (1985–1986).
Wright, G. D., McLellan, D. L. & Brice, J. G. A double-blind trial of chronic cerebellar stimulation in twelve patients with severe epilepsy. J. Neurol. Neurosurg. Psychiatry 47, 769–774 (1984).
Van Buren, J. M., Wood, J. H., Oakley, J. & Hambrecht, F. Preliminary evaluation of cerebellar stimulation by double-blind stimulation and biological criteria in the treatment of epilepsy. J. Neurosurg. 48, 407–416 (1978).
Limousin, P. et al. Effect of parkinsonian signs and symptoms of bilateral subthalamic nucleus stimulation. Lancet 345, 91–95 (1995).
Morris, G. L. 3rd & Mueller, W. M. Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. The Vagus Nerve Stimulation Study Group E01–E05. Neurology 53, 1731–1735 (1999).
Durand, D. M. Control of seizure activity by electrical stimulation: effect of frequency. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2009, 2375 (2009).
Oakley, J. C. & Ojemann, G. A. Effects of chronic stimulation of the caudate nucleus on a preexisting alumina seizure focus. Exp. Neurol. 75, 360–367 (1982).
Morris, G. L. 3rd et al. Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 81, 1453–1459 (2013).
DeGiorgio, C. M. et al. Randomized controlled trial of trigeminal nerve stimulation for drug-resistant epilepsy. Neurology 80, 786–791 (2013).
Rossi, S., Hallett, M., Rossini, P. M. & Pascual-Leone, A. & Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin. Neurophysiol. 120, 2008–2039 (2009).
Lesser, R. P., Crone, N. E. & Webber, W. R. Using subdural electrodes to assess the safety of resections. Epilepsy Behav. 20, 223–229 (2011).
Graber, K. & Fisher, R. in Jasper's Basic Mechanisms Of The Epilepsies 4th edn (eds Noebels, J. L. et al.) (Oxford University Press, 2012).
Wyckhuys, T. et al. Deep brain stimulation for epilepsy: knowledge gained from experimental animal models. Acta Neurol. Belg. 109, 63–80 (2009).
Fisher, R. S. Deep brain stimulation for epilepsy. Handb. Clin. Neurol. 116, 217–234 (2013).
Cooke, P. M. & Snider, R. S. Some cerebellar influences on electrically-induced cerebral seizures. Epilepsia 4, 19–28 (1955).
Dow, R. S., Fernandez-Guardiola, A. & Manni, E. The influence of the cerebellum on experimental epilepsy. Electroencephalogr. Clin. Neurophysiol. 14, 383–398 (1962).
Babb, T. L., Mitchell, A. G. Jr & Crandall, P. H. Fastigiobulbar and dentatothalamic influences on hippocampal cobalt epilepsy in the cat. Electroencephalogr. Clin. Neurophysiol. 36, 141–154 (1974).
Lockard, J. S., Ojemann, G. A., Congdon, W. C. & DuCharme, L. L. Cerebellar stimulation in alumina-gel monkey model: inverse relationship between clinical seizures and EEG interictal bursts. Epilepsia 20, 223–234 (1979).
Laxer, K. D., Robertson, L. T., Julien, R. M. & Dow, R. S. Phenytoin: relationship between cerebellar function and epileptic discharges. Adv. Neurol. 27, 415–427 (1980).
Rosenow, J., Das, K., Rovit, R. L. & Couldwell, W. T. Irving S. Cooper and his role in intracranial stimulation for movement disorders and epilepsy. Stereotact. Funct. Neurosurg. 78, 95–112 (2002).
Cooper, I. S. et al. Safety and efficacy of chronic cerebellar stimulation. Appl. Neurophysiol. 40, 124–134 (1977).
Cooper, I. S. & Upton, A. R. Effects of cerebellar stimulation on epilepsy, the EEG and cerebral palsy in man. Electroencephalogr. Clin. Neurophysiol. Suppl. 34, 349–354 (1978).
Krauss, G. L. & Fisher, R. S. Cerebellar and thalamic stimulation for epilepsy. Adv. Neurol. 63, 231–245 (1993).
Velasco, F. et al. Double-blind, randomized controlled pilot study of bilateral cerebellar stimulation for treatment of intractable motor seizures. Epilepsia 46, 1071–1081 (2005).
Fountas, K. N., Kapsalaki, E. & Hadjigeorgiou, G. Cerebellar stimulation in the management of medically intractable epilepsy: a systematic and critical review. Neurosurg. Focus 29, E8 (2010).
Starzl, T., Taylor, C. & Magoun, H. Ascending conduction in reticular activating system, with special reference to the diencephalon. J. Neurophysiol. 14, 479–496 (1951).
Eckert, U. et al. Preferential networks of the mediodorsal nucleus and centromedian-parafascicular complex of the thalamus—a DTI tractography study. Hum. Brain Mapp. 33, 2627–2637 (2012).
Velasco, F., Velasco, M., Ogarrio, C. & Fanghanel, G. Electrical stimulation of the centromedian thalamic nucleus in the treatment of convulsive seizures: a preliminary report. Epilepsia 28, 421–430 (1987).
Fisher, R. S. et al. Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of intractable seizures. Epilepsia 33, 841–851 (1992).
Velasco, F. et al. Electrical stimulation of the centromedian thalamic nucleus in control of seizures: long-term studies. Epilepsia 36, 63–71 (1995).
Valentin, A. et al. Centromedian thalamic nuclei deep brain stimulation in refractory status epilepticus. Brain Stimul. 5, 594–598 (2012).
Pasnicu, A., Denoyer, Y., Haegelen, C., Pasqualini, E. & Biraben, A. Modulation of paroxysmal activity in focal cortical dysplasia by centromedian thalamic nucleus stimulation. Epilepsy Res. 104, 264–268 (2013).
Valentin, A. et al. Deep brain stimulation of the centromedian thalamic nucleus for the treatment of generalized and frontal epilepsies. Epilepsia 54, 1823–1833 (2013).
Albensi, B. C., Ata, G., Schmidt, E., Waterman, J. D. & Janigro, D. Activation of long-term synaptic plasticity causes suppression of epileptiform activity in rat hippocampal slices. Brain Res. 998, 56–64 (2004).
Akman, T. et al. Effects of the hippocampal deep brain stimulation on cortical epileptic discharges in penicillin-induced epilepsy model in rats. Turk. Neurosurg. 21, 1–5 (2011).
Bragin, A., Wilson, C. L. & Engel, J. Jr. Increased afterdischarge threshold during kindling in epileptic rats. Exp. Brain Res. 144, 30–37 (2002).
Bragin, A., Wilson, C. L. & Engel, J. Jr. Rate of interictal events and spontaneous seizures in epileptic rats after electrical stimulation of hippocampus and its afferents. Epilepsia 43 (Suppl. 5), 81–85 (2002).
Sramka, M., Fritz, G., Galanda, M. & Nadvornik, P. Some observations in treatment stimulation of epilepsy. Acta Neurochir. (Wien) 23, 257–262 (1976).
Velasco, M. et al. Subacute electrical stimulation of the hippocampus blocks intractable temporal lobe seizures and paroxysmal EEG activities. Epilepsia 41, 158–169 (2000).
Velasco, A. L. et al. Electrical stimulation of the hippocampal epileptic foci for seizure control: a double-blind, long-term follow-up study. Epilepsia 48, 1895–1903 (2007).
Boex, C. et al. Chronic deep brain stimulation in mesial temporal lobe epilepsy. Seizure 20, 485–490 (2011).
Cukiert, A., Cukiert, C. M., Burattini, J. A. & Lima, A. M. Seizure outcome after hippocampal deep brain stimulation in a prospective cohort of patients with refractory temporal lobe epilepsy. Seizure 23, 6–9 (2014).
Vonck, K. et al. A decade of experience with deep brain stimulation for patients with refractory medial temporal lobe epilepsy. Int. J. Neural Syst. 23, 1250034 (2013).
Koubeissi, M. Z., Kahriman, E., Syed, T. U., Miller, J. & Durand, D. M. Low-frequency electrical stimulation of a fiber tract in temporal lobe epilepsy. Ann. Neurol. 74, 223–231 (2013).
MacLean, P. D. Psychosomatic disease and the visceral brain; recent developments bearing on the Papez theory of emotion. Psychosom. Med. 11, 338–353 (1949).
Mirski, M. A. & Ferrendelli, J. A. Selective metabolic activation of the mammillary bodies and their connections during ethosuximide-induced suppression of pentylenetetrazol seizures. Epilepsia 27, 194–203 (1986).
Mirski, M. A. & Ferrendelli, J. A. Interruption of the mammillothalamic tract prevents seizures in guinea pigs. Science 226, 72–74 (1984).
Mirski, M. A. & Fisher, R. S. Electrical stimulation of the mammillary nuclei increases seizure threshold to pentylenetetrazol in rats. Epilepsia 35, 1309–1316 (1994).
Khan, S. et al. High frequency stimulation of the mamillothalamic tract for the treatment of resistant seizures associated with hypothalamic hamartoma. Epilepsia 50, 1608–1611 (2009).
van Rijckevorsel, K., Abu Serieh, B., de Tourtchaninoff, M. & Raftopoulos, C. Deep EEG recordings of the mammillary body in epilepsy patients. Epilepsia 46, 781–785 (2005).
Mirski, M. A., Rossell, L. A., Terry, J. B. & Fisher, R. S. Anticonvulsant effect of anterior thalamic high frequency electrical stimulation in the rat. Epilepsy Res. 28, 89–100 (1997).
Bittencourt, S. et al. Microinjection of GABAergic agents into the anterior nucleus of the thalamus modulates pilocarpine-induced seizures and status epilepticus. Seizure 19, 242–246 (2010).
Zhong, X. L. et al. Low-frequency stimulation of bilateral anterior nucleus of thalamus inhibits amygdale-kindled seizures in rats. Brain Res. Bull. 86, 422–427 (2011).
Jou, S. B., Kao, I. F., Yi, P. L. & Chang, F. C. Electrical stimulation of left anterior thalamic nucleus with high-frequency and low-intensity currents reduces the rate of pilocarpine-induced epilepsy in rats. Seizure 22, 221–229 (2013).
Lado, F. A. Chronic bilateral stimulation of the anterior thalamus of kainate-treated rats increases seizure frequency. Epilepsia 47, 27–32 (2006).
Cooper, I. S. et al. Evoked metabolic responses in the limbic-striate system produced by stimulation of anterior thalamic nucleus in man. Int. J. Neurol. 18, 179–187 (1984).
Upton, A. R. et al. Evoked metabolic responses in the limbic-striate system produced by stimulation of anterior thalamic nucleus in man. Pacing Clin. Electrophysiol. 10, 217–225 (1987).
Sussman, N. et al. Anterior thalamic stimulation in medically intractable epilepsy. Part II. preliminary clinical results. Epilepsia 29, 677 (1988).
Hodaie, M., Wennberg, R. A., Dostrovsky, J. O. & Lozano, A. M. Chronic anterior thalamus stimulation for intractable epilepsy. Epilepsia 43, 603–608 (2002).
Osorio, I., Overman, J., Giftakis, J. & Wilkinson, S. B. High frequency thalamic stimulation for inoperable mesial temporal epilepsy. Epilepsia 48, 1561–1571 (2007).
Graves, N. M. & Fisher, R. S. Neurostimulation for epilepsy, including a pilot study of anterior nucleus stimulation. Clin. Neurosurg. 52, 127–134 (2005).
Lee, K. J., Shon, Y. M. & Cho, C. B. Long-term outcome of anterior thalamic nucleus stimulation for intractable epilepsy. Stereotact. Funct. Neurosurg. 90, 379–385 (2012).
Fisher, R. et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia 51, 899–908 (2010).
Salanova, V. et al. Long term efficacy of the SANTE trial (Stimulation of the Anterior Nucleus of Thalamus for Epilepsy). Epilepsy Curr. 13 (Suppl. 1), 123 (2012).
Stypulkowski, P. H., Giftakis, J. E. & Billstrom, T. M. Development of a large animal model for investigation of deep brain stimulation for epilepsy. Stereotact. Funct. Neurosurg. 89, 111–122 (2011).
Elisevich, K., Jenrow, K., Schuh, L. & Smith, B. Long-term electrical stimulation-induced inhibition of partial epilepsy. Case report. J. Neurosurg. 105, 894–897 (2006).
Velasco, A. L. et al. Neuromodulation of epileptic foci in patients with non-lesional refractory motor epilepsy. Int. J. Neural Syst. 19, 139–147 (2009).
Velasco, A., Vazquez, D. & Velasco, F. Open-loop chronic electrical stimulation (CHES) of epileptic foci localized in primary and supplementary motor cortices with nonlesional MRI. Epilepsia 54 (Suppl. 6), 112 (2013).
Sun, F. T., Morrell, M. J. & Wharen, R. E. Jr. Responsive cortical stimulation for the treatment of epilepsy. Neurotherapeutics 5, 68–74 (2008).
Kossoff, E. H. et al. Effect of an external responsive neurostimulator on seizures and electrographic discharges during subdural electrode monitoring. Epilepsia 45, 1560–1567 (2004).
Fountas, K. N. et al. Implantation of a closed-loop stimulation in the management of medically refractory focal epilepsy: a technical note. Stereotact. Funct. Neurosurg. 83, 153–158 (2005).
Fountas, K. N. & Smith, J. R. A novel closed-loop stimulation system in the control of focal, medically refractory epilepsy. Acta Neurochir. Suppl. 97, 357–362 (2007).
Osorio, I. et al. Automated seizure abatement in humans using electrical stimulation. Ann. Neurol. 57, 258–268 (2005).
Morrell, M. J. & RNS System Epilepsy Study Group. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology 77, 1295–1304 (2011).
Morrell, M. et al. Long-term safety and efficacy of responsive brain stimulation in adults with medically intractable partial onset seizures. Epilepsy Curr. 14 (Suppl. 1), 467–468 (2013).
Rektor, I., Kuba, R., Brazdil, M. & Chrastina, J. Do the basal ganglia inhibit seizure activity in temporal lobe epilepsy? Epilepsy Behav. 25, 56–59 (2012).
La Grutta, V. et al. A study of caudate inhibition on an epileptic focus in the cat hippocampus. Arch. Int. Physiol. Biochim. 96, 113–120 (1988).
Psatta, D. M. Control of chronic experimental focal epilepsy by feedback caudatum stimulations. Epilepsia 24, 444–454 (1983).
Rakic, L., Buchwald, N. A. & Wyers, E. J. Effects of chronic stimulation of the caudate nucleus on a preexisting alumina seizure focus. Electroencephalogr. Clin. Neurophysiol. 14, 809–823 (1962).
Sramka, M. & Chkhenkeli, S. A. Clinical experience in intraoperational determination of brain inhibitory structures and application of implanted neurostimulators in epilepsy. Stereotact. Funct. Neurosurg. 54–55, 56–59 (1990).
Gabasvili, V., Chkhenkeli, S. & Sramka, M. The treatment of status epilepticus by electrostimulation of deep brain structures. Presented at the 1st European Congress of Neurology (1988).
Chkhenkeli, S. A. et al. Electrophysiological effects and clinical results of direct brain stimulation for intractable epilepsy. Clin. Neurol. Neurosurg. 106, 318–329 (2004).
Vercueil, L. et al. High-frequency stimulation of the subthalamic nucleus suppresses absence seizures in the rat: comparison with neurotoxic lesions. Epilepsy Res. 31, 39–46 (1998).
Dybdal, D. & Gale, K. Postural and anticonvulsant effects of inhibition of the rat subthalamic nucleus. J. Neurosci. 20, 6728–6733 (2000).
Veliskova, J., Velísek, L. & Moshé, S. L. Subthalamic nucleus: a new anticonvulsant site in the brain. Neuroreport 7, 1786–1788 (1996).
Lado, F. A., Velísek, L. & Moshé, S. The effect of electrical stimulation of the subthalamic nucleus on seizures is frequency dependent. Epilepsia 47, 27–32 (2003).
Chabardes, S. et al. Deep brain stimulation in epilepsy with particular reference to the subthalamic nucleus. Epileptic Disord. 4 (Suppl. 3), S83–S93 (2002).
Capecci, M. et al. Chronic bilateral subthalamic stimulation after anterior callosotomy in drug-resistant epilepsy: long-term clinical and functional outcome of two cases. Epilepsy Res. 98, 135–139 (2012).
Handforth, A., DeSalles, A. A. & Krahl, S. E. Deep brain stimulation of the subthalamic nucleus as adjunct treatment for refractory epilepsy. Epilepsia 47, 1239–1241 (2006).
Faber, J. & Vladyka, V. Antiepileptic effect of electric stimulation of the locus coeruleus in man. Act. Nerv. Super. (Praha) 25, 304–308 (1983).
Feinstein, B., Gleason, C. A. & Libet, B. Stimulation of locus coeruleus in man. Preliminary trials for spasticity and epilepsy. Stereotact. Funct. Neurosurg. 52, 26–41 (1989).
Wille, C. et al. Chronic high-frequency deep-brain stimulation in progressive myoclonic epilepsy in adulthood—report of five cases. Epilepsia 52, 489–496 (2011).
Marino Júnior, R. & Gronich, G. Corpus callosum stimulation and stereotactic callosotomy in the management of refractory generalized epilepsy. Preliminary communication. Arq. Neuropsiquiatr. 47, 320–325 (1989).
Franzini, A. et al. Deep brain stimulation of two unconventional targets in refractory non-resectable epilepsy. Stereotact. Funct. Neurosurg. 86, 373–381 (2008).
Cif, L. et al. Deep brain stimulation in myoclonus-dystonia syndrome. Mov. Disord. 19, 724–727 (2004).
McGovern, R. A. et al. Unchanged safety outcomes in deep brain stimulation surgery for Parkinson disease despite a decentralization of care. J. Neurosurg. 119, 1546–1555 (2013).
Blomstedt, P. & Hariz, M. I. Hardware-related complications of deep brain stimulation: a ten year experience. Acta Neurochir. (Wien) 147, 1061–1064 (2005).
Oh, M. Y., Abosch, A., Kim, S. H., Lang, A. E. & Lozano, A. M. Long-term hardware-related complications of deep brain stimulation. Neurosurgery 50, 1268–1276 (2002).
Boviatsis, E. J., Stavrinou, L. C., Themistocleous, M., Kouyialis, A. T. & Sakas, D. E. Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature. Acta Neurochir. (Wien) 152, 2053–2062 (2010).
Sharma, A., Szeto, K. & Desilets, A. R. Efficacy and safety of deep brain stimulation as an adjunct to pharmacotherapy for the treatment of Parkinson disease. Ann. Pharmacother. 46, 248–254 (2012).
Sansur, C. A. et al. Incidence of symptomatic hemorrhage after stereotactic electrode placement. J. Neurosurg. 107, 998–1003 (2007).
Bhatia, S., Zhang, K., Oh, M., Angle, C. & Whiting, D. Infections and hardware salvage after deep brain stimulation surgery: a single-center study and review of the literature. Stereotact. Funct. Neurosurg. 88, 147–155 (2010).
Kulisevsky, J. et al. Mania following deep brain stimulation for Parkinson's disease. Neurology 59, 1421–1424 (2002).
Nazzaro, J. M., Lyons, K. E., Wetzel, L. H. & Pahwa, R. Use of brain MRI after deep brain stimulation hardware implantation. Int. J. Neurosci. 120, 176–183 (2010).
Gupte, A. A., Shrivastava, D., Spaniol, M. A. & Abosch, A. MRI-related heating near deep brain stimulation electrodes: more data are needed. Stereotact. Funct. Neurosurg. 89, 131–140 (2011).
Ullman, M. et al. A pilot study of human brain tissue post-magnetic resonance imaging: information from the National Deep Brain Stimulation Brain Tissue Network (DBS-BTN). Neuroimage 54 (Suppl. 1), S233–S237 (2011).
Rolston, J. D., Englot, D. J., Wang, D. D., Shih, T. & Chang, E. F. Comparison of seizure control outcomes and the safety of vagus nerve, thalamic deep brain, and responsive neurostimulation: evidence from randomized controlled trials. Neurosurg. Focus 32, E14 (2012).
Oh, Y. S. et al. Cognitive improvement after long-term electrical stimulation of bilateral anterior thalamic nucleus in refractory epilepsy patients. Seizure 21, 183–187 (2012).
Miatton, M. et al. The cognitive effects of amygdalohippocampal deep brain stimulation in patients with temporal lobe epilepsy. Epilepsy Behav. 22, 759–764 (2011).
Coley, E., Farhadi, R., Lewis, S. & Whittle, I. R. The incidence of seizures following deep brain stimulating electrode implantation for movement disorders, pain and psychiatric conditions. Br. J. Neurosurg. 23, 179–183 (2009).
McIntyre, D. C. & Gilby, K. L. Kindling as a model of human epilepsy. Can. J. Neurol Sci. 36, S33–S35 (2009).
Šramka, M., Sedlák, P. & Nádvorník, P. in Neurosurgical Treatment in Psychiatry, Pain and Epilepsy (eds Sweet, W. H. et al.) 651–654 (University Park Press, 1977).
Handforth, A. et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology 51, 48–55 (1998).
Acknowledgements
R.S.F.'s research work is supported by the James and Carrie Anderson fund for epilepsy research, the Susan Horngren Fund, and grant NINCDS NS44601-01.
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R.S.F. researched the data for the article. Both authors contributed substantially to discussion of content, writing the article, and review or editing of the manuscript before submission.
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Stanford University received research funding from Medtronic to participate in the multicentre trial, but R.S.F. receives no personal support from either Medtronic or NeuroPace. R.S.F. has acted as a consultant for, or holds stock options in, ICVRx (cerebrospinal fluid perfusion of drugs), Cyberonics (vagus nerve stimulation), and Intelli-vision (seizure alert). A.L.V. declares no competing interests.
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Fisher, R., Velasco, A. Electrical brain stimulation for epilepsy. Nat Rev Neurol 10, 261–270 (2014). https://doi.org/10.1038/nrneurol.2014.59
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DOI: https://doi.org/10.1038/nrneurol.2014.59
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