[Minimally invasive neurosurgical methods in treatment of pharmacoresistant epilepsy]

The first clinical attempts at neuromodulation in the form of applying functional electrostimulations started some thirty years ago. Nowadays, it is obvious that the approach to neuromodulation and functional electrostimulation has changed significantly. Neuromodulation tends to affect the disturbed function either by the modulation of neuronal signals or by abolition of dysfunction, preserving the intact central nervous system. The mechanism of activity is connected through direct afferent projections, neurotransmitter modulation and neuronal network regulation. NeuroCybernetic Prosthesis (NCP; Cyberonics) is a vagal nerve stimulator consisting of a pulse generator, bipolar VNS lead, programming wand with accompanying software for IBM-compatible computer, a tunneling tool and handheld magnets. NCP is placed on the left vagal nerve (middle cervical part). In 1988, Penry JK et al. inserted the first human implant. The Food and Drug Association indicated VNS as add-on therapy for diminishing the number of seizures in the adults and adolescents over 12 years of age with partial seizures, who are resistant to pharmacological therapy.