Neuromodulation for Refractory Epilepsy
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Three neuromodulation therapies, all using implanted device and electrodes, have been approved to treat adults with drug-resistant focal epilepsy, namely, the vagus nerve stimulation in 1995, deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) in 2018 (2010 in Europe), and responsive neurostimulation (RNS) in 2014. Indications for VNS have more recently extended to children down to age of 4. Limited or anecdotal data are available in other epilepsy syndromes and refractory/super-refractory status epilepticus. Overall, neuromodulation therapies are palliative, with only a minority of patients achieving long-term seizure freedom, justifying favoring such treatments in patients who are not good candidates for curative epilepsy surgery. About half of patients implanted with VNS, ANT-DBS, and RNS have 50% or greater reduction in seizures, with long-term data suggesting increased efficacy over time. Besides their impact on seizure frequency, neuromodulation therapies are associated with various benefits and drawbacks in comparison to antiseizure drugs. Yet, we lack high-level evidence to best position each neuromodulation therapy in the treatment pathways of persons with difficult-to-treat epilepsy.
Originalsprog | Engelsk |
---|---|
Tidsskrift | Epilepsy Currents |
Vol/bind | 22 |
Udgave nummer | 1 |
Sider (fra-til) | 11-17 |
Antal sider | 7 |
ISSN | 1535-7597 |
DOI | |
Status | Udgivet - 2022 |
Eksternt udgivet | Ja |
Bibliografisk note
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by EU’s Horizon 2020 Research and Innovation Programme; 785907 (HBP SGA2); 945539 (HBP SGA3).
Publisher Copyright:
© The Author(s) 2021.
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