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[Invasive stimulation procedures and EEG diagnostics in epilepsy].

A Schulze-Bonhage1, H M Hamer2, M Hirsch3

  • 1Epilepsiezentrum, Neurozentrum, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland. andreas.schulze-bonhage@uniklinik-freiburg.de.

Der Nervenarzt
|July 9, 2016
PubMed
Summary

Invasive stimulation, including vagus nerve stimulation and intracranial methods, offers a therapeutic option for epilepsy. Focused research in experienced centers is crucial for improving efficacy and safety of these advanced treatments.

Keywords:
Drug refractory epilepsyEpilepsy surgeryInvasive diagnosticsNeurostimulationTreatment outcome

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Area of Science:

  • Neurology
  • Neurosurgery
  • Epileptology

Background:

  • Epilepsy treatment has evolved since the 1970s, with invasive stimulation methods like vagus nerve stimulation (VNS) and intracranial stimulation (ICS) emerging as therapeutic options.
  • While VNS is widely used, particularly in the USA, ICS availability varies regionally, highlighting a need for standardization and data sharing.
  • Invasive electroencephalographic (EEG) monitoring is increasingly employed for presurgical evaluation when non-invasive methods are insufficient to localize the epileptogenic zone.

Purpose of the Study:

  • To review the current status and future directions of invasive stimulation for epilepsy treatment.
  • To emphasize the need for concentration on experienced centers and multicenter data acquisition to enhance efficacy and safety.
  • To discuss the role and outcomes of invasive EEG monitoring in presurgical epilepsy evaluation.

Main Methods:

  • Review of historical and current practices in epilepsy stimulation therapies.
  • Analysis of the utilization and regional availability of VNS and ICS.
  • Description of invasive EEG monitoring techniques, including subdural and depth electrodes.
  • Discussion of complication rates and outcomes associated with invasive monitoring.

Main Results:

  • Invasive stimulation, though developing rapidly, remains infrequently used in Europe compared to VNS in the USA.
  • Invasive EEG monitoring offers superior seizure localization compared to non-invasive methods when initial diagnostics are inconclusive.
  • Complications from invasive monitoring are rare (≤2%), with lasting deficits or death being uncommon.

Conclusions:

  • Further development of invasive stimulation requires a focus on experienced centers and collaborative data sharing to improve treatment efficacy and minimize risks.
  • Invasive EEG monitoring is a valuable, albeit complex, tool for presurgical epilepsy evaluation, yielding better seizure control rates than drug therapy alone.
  • Standardizing criteria and sharing data are essential for advancing invasive stimulation as a safe and effective epilepsy treatment option.