Dual strategies for epilepsy management employing pharmacological and non-invasive brain stimulation approaches

Epilepsy is a prevalent neurological disorder that affects more than 50 million individuals worldwide, characterized by seizures, and is often associated with complications such as cognitive impairments, and an increased risk of sudden unexpected death in epilepsy (SUDEP). Despite advancements in pharmacological treatments, one-third of patients develop drug resistance and some experience serious side effects related to drug therapy. This highlights the urgent need for alternative therapeutic approaches. Non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial ultrasound stimulation (TUS), have emerged as promising alternatives. These methods modulate brain activity with fewer side effects and show potential for treating drug-resistant epilepsy. However, their clinical application is still limited by factors such as variability in stimulation protocols and patient responsiveness. This review explores the efficacy, underlying mechanisms, and side effects of pharmacological treatments, with a focus on commonly prescribed drugs for epilepsy, as well as selected NIBS techniques, emphasizing their roles in managing epilepsy. By comparing these approaches, we aim to provide insights into optimizing epilepsy treatment strategies and improving patient outcomes. This review suggests that NIBS alone or in combination with pharmacological therapy is a promising method for patients with epilepsy and future research should focus on the effective protocols and related mechanisms.