Deep Brain Stimulation Therapy for Drug-Resistant Epilepsy: Present and Future Perspectives

Area of Science:

• Neurology
• Neurosurgery
• Biomedical Engineering

Background:

• Drug-resistant epilepsy (DRE) affects 30-40% of patients, posing significant clinical challenges.
• Neuromodulatory therapies, particularly deep brain stimulation (DBS), are crucial for patients unsuitable for resective surgery.
• DBS provides a viable and reversible treatment alternative for managing DRE.

Purpose of the Study:

• To critically review current applications of DBS for DRE.
• To examine major and emerging DBS targets for epilepsy treatment.
• To discuss therapeutic mechanisms, technological advancements, and future directions in DBS for DRE.

Main Methods:

• Narrative review integrating data from randomized controlled trials and observational studies.
• Analysis of advanced imaging, sensing technologies, and connectivity mapping.
• Discussion of therapeutic mechanisms, including cellular and network modulation.

Main Results:

• DBS is an established neuromodulatory therapy for DRE.
• Key targets include the anterior thalamic nucleus, centromedian nucleus, hippocampus, and pulvinar.
• Advances in sensing and closed-loop systems show promise for personalized treatment.

Conclusions:

• DBS is a valuable, reversible treatment for DRE when surgery is not feasible.
• Understanding network modulation and neuroplasticity is key to optimizing DBS efficacy.
• Future research should focus on refining targets, enhancing sensing technologies, and developing closed-loop systems for improved clinical outcomes.