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[Invasive neurostimulation as adjunct treatment for epilepsy]
G Möddel1, V A Coenen, C E Elger
1Klinik für Epileptologie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Deutschland. Gabriel.moeddel@ukb.uni-bonn.de
Der Nervenarzt
|July 18, 2012
Summary
Neurostimulation, including vagus nerve stimulation (VNS), anterior nucleus of the thalamus deep brain stimulation (ANT-DBS), and responsive neurostimulation (RNS), effectively reduces epileptic seizure frequency and severity.
Area of Science:
- Neurology
- Neurosurgery
- Biomedical Engineering
Context:
- Epilepsy management remains a challenge, necessitating advanced therapeutic strategies.
- Neurostimulation offers a promising avenue for refractory epilepsy.
- Current evidence reviews established and emerging neurostimulation techniques.
Purpose:
- To evaluate the efficacy and side-effect profiles of Vagus Nerve Stimulation (VNS), Anterior Nucleus Deep Brain Stimulation (ANT-DBS), and Responsive Neurostimulation (RNS) for epilepsy treatment.
- To compare these interventions against placebo or control groups.
- To identify patient subgroups that may benefit most from specific neurostimulation modalities.
Summary:
- Vagus nerve stimulation (VNS) demonstrated a 25-28% seizure reduction versus 6-15% in controls, with open-label studies suggesting higher efficacy.
- Anterior nucleus deep brain stimulation (ANT-DBS) showed a 40.4% seizure reduction in a randomized controlled trial, particularly in patients with temporal seizure onset, with 13% achieving seizure freedom.
- Responsive neurostimulation (RNS) resulted in a 37.9% seizure reduction compared to 17.3% in controls, with no significant neuropsychological or psychiatric side-effects.
Impact:
- Neurostimulation techniques provide significant seizure reduction for epilepsy patients.
- ANT-DBS and RNS present viable therapeutic options with distinct efficacy and safety profiles.
- Further research into personalized neurostimulation approaches is warranted.
