Passive neuromodulation: an energy-driven mechanism for closed-loop suppression of epileptic seizures

For decades, electrical neuromodulation has been used as a therapeutic mechanism to disrupt and desynchronize pathological neural activity in various neurological disorders. Despite notable progress, however, patient outcomes remain highly variable, particularly in medically intractable epilepsy where surgery still provides the greatest chance of seizure freedom. Here we propose passive neuromodulation (PNM) as a radical alternative to conventional neurostimulation, whereby analogue feedback is used to drain energy from an epileptic circuit and thus suppress the initiation or spread of electrographic seizures. We provide pilot evidence on the efficacy and robustness of PNM using two computational models of epileptic dynamics: a detailed biophysical network model of dentate gyrus, and the Epileptor neural mass model of seizure dynamics. Despite the vast differences between these models, our results show the robust ability of PNM to suppress seizures in both models. We further demonstrate the efficacy and robustness of responsive PNM, whereby brief (50ms) windows of PNM are triggered by a simultaneously-running seizure detection algorithm, as well as the safe and tunable nature of PNM, where more robust seizure suppression can be achieved by parametrically titrating the amount of power drained from the tissue, without inducing any seizures even if applied interictally. Overall, our results provide strong evidence on the promise of PNM for the closed-loop control of epileptic seizures and other neurological disorders where damping pathological network activity can restore healthy dynamics.