Skip to main content
SpringerLink
Log in

Invasive Hirnstimulationsverfahren in der Epilepsietherapie

Invasive stimulation techniques in epilepsy therapy

  • Originalarbeit
  • Published:
Zeitschrift für Epileptologie Aims and scope Submit manuscript

Zusammenfassung

Epilepsiepatienten, denen weder pharmakologische noch epilepsiechirurgische Therapien helfen oder angeboten werden können, stehen wenige ergänzende therapeutische Verfahren zu Verfügung. Methoden der Hirnstimulation wie die Vagusnervstimulation (VNS) oder die Tiefenhirnstimulation („deep brain stimulation“, DBS) gehören dazu. Angesichts der ungünstigen Prognosen therapierefraktärer oder katastrophaler Epilepsien sind diese Verfahren Gegenstand vielfältiger Forschungsbemühungen. Der folgende Beitrag soll eine Einleitung in Erkenntnisse und Perspektiven invasiver Stimulationsverfahren unter Berücksichtigung der gegenwärtigen klinischen Praxis geben.

Abstract

For patients with epilepsy not responding or not being eligible for pharmacological treatment or epilepsy surgery, therapeutic options are limited. Alternative therapeutic options include methods of brain stimulation like vagus nerve stimulation (VNS) or deep brain stimulation (DBS). In recent years, these methods have been subject of considerable research efforts given the unfavorable prognosis of refractory or catastrophic epilepsies. The following review provides a basic introduction into clinical praxis, current knowledge and prospects of invasive stimulation techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Aldenkamp AP, Majoie HJ, Berfelo MW et al (2002) Long-term effects of 24-month treatment with vagus nerve stimulation on behaviour in children with Lennox-Gastaut syndrome. Epilepsy Behav 3(5):475–479

    Article  PubMed  Google Scholar 

  2. Annegers JF, Coan SP, Hauser WA, Leestma J (2004) Epilepsy, vagal nerve stimulation by the NCP system, all-cause mortality and sudden, unexpected, unexplained death. Epilepsia 41(5):549–553

    Article  Google Scholar 

  3. Bartholow R (1874) Experimental investigations into the functions of the human brain. Am J Med Sci 67:305–313

    Article  Google Scholar 

  4. Benabid AL, Pollak P, Gervason C et al (1991) Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet 16:403–406

    Article  Google Scholar 

  5. Benabid AL, Minotti L, Koudsie A et al (2002) Antiepileptic effect of high-frequency stimulation of the subthalamic nucleus (corpus Luysi) in a case of medically intractable epilepsy caused by focal dysplasia: a 30-month follow-up: technical case report. Neurosurgery 50:1385–1391

    Article  PubMed  Google Scholar 

  6. Ben-Menachem E (2002) Vagus-nerve stimulation for the treatment of epilepsy. Lancet Neurol 1:477–482

    Article  PubMed  Google Scholar 

  7. Ben-Menachem E, Manon-Espaillat R, Ristanovic R et al (1994) Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. Epilepsia 35(3):616–626

    Article  CAS  PubMed  Google Scholar 

  8. Berney A, Vingerhoets F, Perrin A et al (2002) Effect on mood of subthalamic DBS for Parkinson’s disease: a consecutive series of 24 patients. Neurology 59:1427–1429

    CAS  PubMed  Google Scholar 

  9. Bingaman WE (2008) Vagal nerve stimulation: surgical technique and complications. In: Lüders HO (ed) Textbook of epilepsy surgery. Informa Healthcare, London, pp 1184–1187

  10. Blumenfeld H, McCormick DA (2000) Corticothalamic inputs control the pattern of activity generated in thalamocortical networks. J Neurosci 20:5153–5162

    CAS  PubMed  Google Scholar 

  11. Boon P, Vonck K, De Herdt V et al (2007) Deep brain stimulation in patients with refractory temporal lobe epilepsy. Epilepsia 48(8):1551–1560

    Article  PubMed  Google Scholar 

  12. Catenoix H, Mauguière F, Guénot M et al (2008) SEEG-guided thermocoagulations – a palliative treatment of nonoperable partial epilepsies. Neurology 71:1719–1726

    Article  CAS  PubMed  Google Scholar 

  13. Chase MH, Nakamura Y (1968) Cortical and subcortical EEG patterns of response to afferent abdominal vagal stimulation: neurographic correlates. Physiol Behav 3:605–610

    Article  Google Scholar 

  14. Cooper IS (1973) Effect of chronic stimulation of anterior cerebellum on neurological disease. Lancet 1(7796):206

    Article  CAS  PubMed  Google Scholar 

  15. Cooper IS, Amin I, Riklan M et al (1976) Chronic cerebellar stimulation in epilepsy. Clinical and anatomical studies. Arch Neurol 33(8):559–570

    CAS  PubMed  Google Scholar 

  16. Dedeurwaerdere S, Vonck K et al (2004) Acute vagus nerve stimulation does not suppress spike and wave discharges in genetic absence epilepsy rats from Strasbourg. Epilepsy Res 59:191–198

    Article  PubMed  Google Scholar 

  17. DeGiorgio CM, Shewmon A, Murray D, Whitehurst T (2006) Pilot study of trigeminal nerve stimulation (TNS) for epilepsy: a proof-of-concept trial. Epilepsia 47(7):1213–1215

    Article  PubMed  Google Scholar 

  18. Deransart C, Depaulis A (2008) Experimental evidence for the involvement of the basal ganglia in the control of epilepsy. In: Lüders HO (ed) Textbook of epilepsy surgery. Informa Healthcare, London, pp 1201–1207

  19. Diederich NJ, Alesch F, Goetz C (2000) Visual hallucinations induced by deep brain stimulation in Parkinson’s disease. Clin Neuropharmacol 23:287–289

    Article  CAS  PubMed  Google Scholar 

  20. Dorr AE, Debonnel G (2006) Effect of vagus nerve stimulation on serotonergic and noradrenergic transmission. J Pharmacol Exp Ther 318:890–898

    Article  CAS  PubMed  Google Scholar 

  21. Fanselow EE, Reid AP, Nicolelis MAL (2000) Reduction of pentylenetetrazole-induced seizure activity in awake rats by seizure-triggered trigeminal nerve stimulation. J Neurosci 20(21):8160–8168

    CAS  PubMed  Google Scholar 

  22. Fisher RS, Uematsu S, Krauss G et al (1992) Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of intractable seizures. Epilepsia 33:841–851

    Article  CAS  PubMed  Google Scholar 

  23. Flanigin HF (1989) Depth electrode studies in pre-surgical evaluations (abstract). Electromyogr Clin Neurophysiol 73:67P

    Google Scholar 

  24. Foley JO, DuBois F (1937) Quantitative studies of the vagus nerve in the cat. I. The ratio of sensory to motor fibers. J Comp Neurol 67:49–67

    Article  Google Scholar 

  25. Fountas KN, Smith JR, Murro AM et al (2005) Implantation of a closed-loop stimulation in the management of medically refractory focal epilepsy: a technical note. Stereotact Funct Neurosurg 83(4):153–158

    Article  PubMed  Google Scholar 

  26. Franzini A, Ferroli P, Leone M, Broggi G (2003) Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery 52(5):1095–1099

    Article  PubMed  Google Scholar 

  27. Fritsch G, Hitzig E (1870) Über die elektrische Erregbarkeit des Großhirnes. Arch Anat Physiol Wiss Med 37:300–332

    Google Scholar 

  28. Gaitatzis A, Johnson AL, Chadwick DW et al (2004) Life expectancy in people with newly diagnosed epilepsy. Brain 127:2427–2432

    Article  PubMed  Google Scholar 

  29. Hallbook T, Lundgren J, Blennow G et al (2005) Long term effects on epileptiform activity with vagus nerve stimulation in children. Seizure 14(8):527–533

    Article  PubMed  Google Scholar 

  30. Hamani C, Hodaie M, Lozano AM (2005) Present and future of deep brain stimulation for refractory epilepsy. Acta Neurochir 147:227–229

    Article  CAS  Google Scholar 

  31. Hammond EJ, Uthman BM, Reid SA, Wilder BJ (1992) Electrophysiological studies of cervical vagus nerve stimulation in humans: 1. EEG effects. Epilepsia 33(6):1013–1020

    Article  CAS  PubMed  Google Scholar 

  32. Handforth A, De Giorgio CM, Schachter SC et al (1998) Vagus nerve stimulation therapy for partial-onset seizures: a randomized active control trial. Neurology 51(1):48–55

    CAS  PubMed  Google Scholar 

  33. Herzog R, Voges J, Ghaemi M et al (2003) Deep brain stimulation of the subthalamic nucleus does not increase the striatal dopamine concentration in parkinsonian humans. Mov Disord 18:41–48

    Article  Google Scholar 

  34. Hodaie M, Wennberg RA, Dostrovsky JO, Lozano AM (2002) Chronic anterior thalamus stimulation for intractable epilepsy. Epilepsia 43(6):603–608

    Article  PubMed  Google Scholar 

  35. Houeto JL, Karachi C, Mallet L (2005) Tourette’s syndrome and deep brain stimulation. J Neurol Neurosurg Psychiatry 76(7):992–995

    Article  CAS  PubMed  Google Scholar 

  36. Jensen AL, Durand DM (2007) Suppression of axonal conduction by sinusoidal stimulation in rat hippocampus in vitro. J Neural Eng 4:1–16

    Article  CAS  PubMed  Google Scholar 

  37. Kellinghaus C, Loddenkemper T, Möddel G et al (2003) Elektrische Hirnstimulation in der Epilepsietherapie. Nervenarzt 74:664–676

    Article  CAS  PubMed  Google Scholar 

  38. Koo B (2001) EEG changes with vagus-nerve stimulation. J Clin Neurophysiol 18(5):434–441

    Article  CAS  PubMed  Google Scholar 

  39. Kringelbach ML, Jenkinson N, Owen SLF, Aziz TZ (2007) Translational principles of deep brain stimulation. Nat Rev Neurosci 8(8):623–635

    Article  CAS  PubMed  Google Scholar 

  40. Kuba R, Guzaninova M, Brazdil M et al (2002) Effect of vagal nerve stimulation on interictal epileptiform discharges: a scalp EEG study. Epilepsia 43(10):1181–1188

    Article  PubMed  Google Scholar 

  41. Kupsch A, Benecke R, Müller J et al (2006) Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med 355:1978–1990

    Article  CAS  PubMed  Google Scholar 

  42. Lee GP, Bechara A, Adolphs R et al (1997) Clinical and physiological effects of stereotaxic bilateral amygdalotomy for intractable aggression. J Neuropsychiatry 10:413–420

    Google Scholar 

  43. Lefaucheur J-P (2008) Principles of therapeutic use of transcranial and epidural cortical stimulation. Clin Neurophysiol 119:2179–2184

    Article  PubMed  Google Scholar 

  44. Lesser RP, Kim SH, Beyderman L et al (1999) Brief bursts of pulse stimulation terminate afterdischarges caused by cortical stimulation. Neurology 53:2073–2081

    CAS  PubMed  Google Scholar 

  45. Lockard JS, Congdon WC, DuCharme LL (1990) Feasibility and safety of vagal stimulation in monkey model. Epilepsia 31 [Suppl 2]:S20–S26

  46. Loddenkemper T, Pan A, Neme S et al (2001) Deep brain stimulation in epilepsy. J Clin Neurophysiol 18(6):514–532

    Article  CAS  PubMed  Google Scholar 

  47. Mayberg HS, Lozano AM, Voon V et al (2005) Deep brain stimulation for treatment-resistant depression. Neuron 45:651–660

    Article  CAS  PubMed  Google Scholar 

  48. Morrell M (2006) Brain stimulation for epilepsy: can scheduled or responsive neurostimulation stop seizures? Curr Opin Neurol 19:164–168

    Article  PubMed  Google Scholar 

  49. Morris GL 3rd, Mueller WM (1999) Long-term treatment with vagus nerve stimulation in patients with refractory epilepsy. The Vagus Nerve Stimulation Study Group E01-E05. Neurology 53(8):1731–1735

    PubMed  Google Scholar 

  50. Narabayashi H, Nagao T, Saito Y et al (1963) Stereotaxic amygdalotomy for behavior disorders. Arch Neurol 9:1–16

    CAS  PubMed  Google Scholar 

  51. Nowak LG, Bullier J (1998) Axons, but not cell bodies are activated by electrical stimulation in cortical gray matter. Exp Brain Res 118:477–488

    Article  CAS  PubMed  Google Scholar 

  52. Parain D, Penniello MJ, Berquen P et al (2001) Vagal nerve stimulation in tuberous sclerosis complex patients. Pediatr Neurol 25(3):213–216

    Article  CAS  PubMed  Google Scholar 

  53. Parent A, Hazrati LN (1995) Functional anatomy of the basal ganglia. II. The place of subthalamic nucleus and external pallidum in basal ganglia circuitry. Brain Res Rev 20:128–154

    Article  CAS  PubMed  Google Scholar 

  54. Patwardhan RV, Stong B, Bebin EM et al (2000) Efficacy of vagal nerve stimulation in children with medically refractory epilepsy. Neurosurgery 47(6):1353–1357

    Article  CAS  PubMed  Google Scholar 

  55. Penalozarojas JH (1964) Electroencephalographic synchronization resulting from direct current application to the vagus nerve. Exp Neurol 9:367–371

    Article  CAS  PubMed  Google Scholar 

  56. Perlmutter JS, Mink JW (2006) Deep brain stimulation. Ann Rev Neurosci 29:229-257

    Article  CAS  PubMed  Google Scholar 

  57. Penry JK, Dean JC (1990) Prevention of intractable partial seizures by intermittent vagal stimulation in humans: preliminary results. Epilepsia 31 [Suppl 2]:S40–S43

  58. Pilitsis JG, Chu Y, Kordower J et al (2008) Postmortem study of deep brain stimulation of the anterior thalamus: case report. Neurosurgery 62:530–532

    Article  Google Scholar 

  59. Ranck JBJ (1975) Which elements are excited in electrical stimulation of mammalian central nervous system: a review. Brain Res 98:417–440

    Article  PubMed  Google Scholar 

  60. Rouzaire-Dubois B, Scarnati E (1987) Pharmacological study of the cortical-induced excitation of subthalamic nucleus neurons in the rat: evidence for amino acids as putative neurotransmitters. Neuroscience 21:429–440

    Article  CAS  PubMed  Google Scholar 

  61. Rutecki P (1990) Anatomical, physiological and theoretical basis for the antiepileptic effect of vagus nerve stimulation. Epilepsia 31 [Suppl 2]:S1–S6

  62. Salinsky MC, Burchiel KJ (1993) Vagus nerve stimulation has no effect on awake EEG rhythms in humans. Epilepsia 34(2):299–304

    Article  CAS  PubMed  Google Scholar 

  63. Schüle SU, McIntyre C, Lüders HO (2008) General principles of cortical mapping by electrical stimulation. In: Lüders HO (ed) Textbook of epilepsy surgery. Informa Healthcare, London, pp 963–977

  64. Spanaki MV, Allen LS, Mueller WM et al (2004) Vagus nerve stimulation therapy: 5-year or greater outcome at a university-based epilepsy center. Seizure 13(8):587–590

    Article  PubMed  Google Scholar 

  65. Stoica I, Tudor I (1968) Vagal trunk stimulation influences on epileptic spiking focus activity. Rev Roum Neurol 5:203–210

    Google Scholar 

  66. Van Buren JM, Wood JH, Oakley J, Hambrecht F (1978) Preliminary evaluation of cerebellar stimulation by double-blind stimulation and biological criteria in the treatment of epilepsy. J Neurosurg 48(3):407–416

    Article  Google Scholar 

  67. Velasco F, Velasco M, Ogarrio C, Fanghanel G (1987) Electrical stimulation of the centromedian thalamic nucleus in the treatment of convulsive seizures: a preliminary report. Epilepsia 28:421–430

    Article  CAS  PubMed  Google Scholar 

  68. Velasco F, Velasco M, Velasco AL et al (1995) Electrical stimulation of the centromedian thalamic nucleus in control of seizures: long-term studies. Epilepsia 36:63–71

    Article  CAS  PubMed  Google Scholar 

  69. Velasco M, Velasco F, Velasco AL et al (2000) Subacute electrical stimulation of the hippocampus blocks intractable temporal lobe seizures and paroxysmal EEG activities. Epilepsia 41(2):158–169

    Article  CAS  PubMed  Google Scholar 

  70. Vidailhet M, Vercueil L, Houeto JL et al (2005) Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. N Engl J Med 352(5):498–500

    Article  Google Scholar 

  71. Vonck K, Boon P, Achten E et al (2002) Long-term amygdalohippocampal stimulation for refractory temporal lobe epilepsy. Ann Neurol 52(5):556–565

    Article  PubMed  Google Scholar 

  72. Weiss G (1901) Sur la possibilité de rendre comparable entre eux les appareils servant a l’excitation électrique. Arch Ital Biol 35:413–446

    Google Scholar 

  73. Woodbury DM, Woodbury JW (1990) Effects of vagal stimulation on experimentally induced seizures in rats. Epilepsia 31 [Suppl 2]:S7–S19

  74. Wright GD, McLellan DL, Brice JG (1984) A double-blind trial of chronic cerebellar stimulation in twelve patients with severe epilepsy. J Neurol Neurosurg Psychiatry 47(8):769–774

    Article  CAS  PubMed  Google Scholar 

  75. Zabara J (1992) Inhibition of experimental seizures in canines by repetitive vagal stimulation. Epilepsia 33(6):1005–1012

    Article  CAS  PubMed  Google Scholar 

  76. Zanchetti A, Wang SC, Moruzzi G (1952) The effect of vagal afferent stimulation on the EEG pattern of the cat. Electromyogr Clin Neurophysiol 4:357–361

    Article  CAS  Google Scholar 

  77. Zhu-Ge ZB, Zhu Y-Y, Wu D-C et al (2007) Unilateral low-frequent stimulation of central piriform cortex inhibits amygdaloid-kindled seizures in Sprague-Dawley rats. Neuroscience 146(3):901–906

    Article  CAS  PubMed  Google Scholar 

  78. Zumsteg D, Lozano AM, Wieser HG, Wennberg RA (2006) Cortical activation with deep brain stimulation of the anterior thalamus for epilepsy. Clin Neurophysiol 117:192–207

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung für Klinische Neurophysiologie, Universitätsklinikum Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    C. Stephani, M.A. Nitsche & W. Paulus

  2. Department of Neurology, Case Western Reserve University, Cleveland, USA

    C. Stephani

Authors
  1. C. Stephani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M.A. Nitsche
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Paulus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Stephani.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stephani, C., Nitsche, M. & Paulus, W. Invasive Hirnstimulationsverfahren in der Epilepsietherapie. Z. Epileptol. 22, 80–88 (2009). https://doi.org/10.1007/s10309-009-0029-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10309-009-0029-x

Schlüsselwörter

Keywords

Search

Navigation