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Electroconvulsive Therapy01:30

Electroconvulsive Therapy

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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
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New and Old Targets: Evolving Framework for Personalized DBS in Refractory Epilepsy.

Nallammai Muthiah1, Jon T Willie2,3

  • 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.

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Summary

Neuromodulation offers significant seizure reduction and improved quality of life for drug-resistant epilepsy (DRE) patients. Advances in neuroimaging and personalized approaches are refining deep brain stimulation (DBS) target selection for better outcomes.

Keywords:
BiomarkersDeep brain stimulationDrug-resistant epilepsyHippocampusNeuromodulationResponsive neurostimulationStereotactic surgeryThalamus

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Area of Science:

  • Neurology
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Drug-resistant epilepsy (DRE) presents a significant challenge in patient care.
  • Neuromodulation techniques, including deep brain stimulation (DBS) and responsive neurostimulation, are crucial palliative options for non-surgical candidates.
  • These methods are increasingly integrated into clinical practice for managing intractable epilepsy.

Purpose of the Study:

  • To review the current landscape and future directions of neuromodulation for drug-resistant epilepsy.
  • To highlight the efficacy and challenges associated with established and emerging deep brain stimulation targets.
  • To discuss advancements that promise to personalize neuromodulation strategies for epilepsy.

Main Methods:

  • Review of randomized trials and long-term studies on neuromodulation for epilepsy.
  • Analysis of evidence supporting traditional and emerging DBS targets.
  • Exploration of novel approaches like adaptive stimulation and advanced neuroimaging.

Main Results:

  • Established DBS targets (thalamus, hippocampus) show durable seizure reduction and quality-of-life improvements.
  • Emerging targets (pulvinar, cerebellum, etc.) require further investigation.
  • Multitarget and multidevice strategies are being explored for highly refractory cases.

Conclusions:

  • Neuromodulation provides meaningful seizure control and enhances quality of life for patients with intractable epilepsy.
  • Personalized treatment approaches, informed by network principles, advanced imaging, and invasive recordings, are key to optimizing DBS target selection.
  • Ongoing research and technological advancements continue to refine neuromodulation therapies for DRE.