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Practical considerations in epilepsy neurostimulation.

Hugh D Simpson1, Andreas Schulze-Bonhage2, Gregory D Cascino1

  • 1Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.

Epilepsia
|June 14, 2022
PubMed
Summary
This summary is machine-generated.

Neuromodulation offers effective seizure reduction for drug-resistant epilepsy. Vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS) are proven safe and beneficial, with efficacy improving over time.

Keywords:
DBS (deep brain stimulation)RNS (responsive stimulation)VNS (vagus nerve stimulation)brain stimulationneuromodulation

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Area of Science:

  • Neurology
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Neuromodulation is a critical treatment for drug-resistant epilepsy.
  • Several neuromodulation devices have established long-term efficacy and real-world data.
  • Patient selection and programming are key to successful neuromodulation therapy.

Purpose of the Study:

  • To provide a practical guide for selecting neuromodulation techniques for epilepsy.
  • To summarize patient selection, programming initiation, and management for VNS, DBS-ANT, and RNS.
  • To inform clinical practice evolution beyond pivotal trial parameters.

Main Methods:

  • Review of randomized controlled trials and long-term follow-up studies.
  • Analysis of efficacy data for Vagus Nerve Stimulation (VNS), Deep Brain Stimulation of the Anterior Nucleus of the Thalamus (DBS-ANT), and Responsive Neurostimulation (RNS).
  • Examination of factors influencing device selection, including epilepsy characteristics and comorbidities.

Main Results:

  • VNS, DBS-ANT, and RNS demonstrate safety and significant seizure reduction, with efficacy improving over 7-10 years.
  • A substantial proportion of patients achieve 6-month seizure-free intervals with all three modalities.
  • Epileptogenic foci number/location and comorbidities influence modality choice and programming parameters.

Conclusions:

  • Clinical practice for neuromodulation in epilepsy has advanced beyond initial trial designs.
  • Tailoring neuromodulation techniques to individual patient profiles enhances treatment outcomes.
  • Emerging noninvasive brain stimulation offers future therapeutic potential.