Neurotherapeutics

, Volume 6, Issue 2, pp 218–227

Electrical stimulation for the treatment of epilepsy

  • Paul Boon
  • Robrecht Raedt
  • Veerle de Herdt
  • Tine Wyckhuys
  • Kristl Vonck
Theme 1: Brain Stimulation and Cooling

DOI: 10.1016/j.nurt.2008.12.003

Cite this article as:
Boon, P., Raedt, R., de Herdt, V. et al. Neurotherapeutics (2009) 6: 218. doi:10.1016/j.nurt.2008.12.003

Summary

Despite the advent of new pharmacological treatments and the high success rate of many surgical treatments for epilepsy, a substantial number of patients either do not become seizure-free or they experience major adverse events (or both). Neurostimulation-based treatments have gained considerable interest in the last decade. Vagus nerve stimulation (VNS) is an alternative treatment for patients with medically refractory epilepsy, who are unsuitable candidates for conventional epilepsy surgery, or who have had such surgery without optimal outcome. Although responder identification studies are lacking, long-term VNS studies show response rates between 40% and 50% and long-term seizure freedom in 5% to 10% of patients. Surgical complications and perioperative morbidity are low. Research into the mechanism of action of VNS has revealed a crucial role for the thalamus and cortical areas that are important in the epileptogenic process. Acute deep brain stimulation (DBS) in various thalamic nuclei and medial temporal lobe structures has recently been shown to be efficacious in small pilot studies. There is little evidence-based information on rational targets and stimulation parameters. Amygdalohippocampal DBS has yielded a significant decrease of seizure counts and interictal EEG abnormalities during long-term follow-up. Data from pilot studies suggest that chronic DBS for epilepsy may be a feasible, effective, and safe procedure. Further trials with larger patient populations and with controlled, randomized, and closed-loop designs should now be initiated. Further progress in understanding the mechanism of action of DBS for epilepsy is a necessary step to making this therapy more efficacious and established.

Key Words

Refractory epilepsy electrical stimulation neurostimulation vagus nerve stimulation hippocampal stimulation epilepsy surgery 

Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2009

Authors and Affiliations

  • Paul Boon
    • 1
  • Robrecht Raedt
    • 1
  • Veerle de Herdt
    • 1
  • Tine Wyckhuys
    • 1
  • Kristl Vonck
    • 1
  1. 1.Reference Center for Refractory Epilepsy, Laboratory for Clinical and Experimental Neurophysiology, Department of Neurology, 1K12IAGhent University HospitalGhentBelgium

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