Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Treatment Options in Neurology
Published in: Current Treatment Options in Neurology 2/2017

01-02-2017 | Epilepsy (E Waterhouse, Section Editor)

Neurostimulation Devices Used in Treatment of Epilepsy

Author: Evren Burakgazi Dalkilic, MD

Published in: Current Treatment Options in Neurology | Issue 2/2017

Login to get access

Opinion statement

Epilepsy is a chronic neurological disorder frequently requiring lifelong treatment. In 70% of epilepsy patients, seizures are well controlled by antiepileptic medications. About 30% of epilepsy patients remain refractory to medical treatments and may need surgical interventions for better seizure control. Unfortunately and not infrequently, surgical intervention is not feasible due to various reasons such as multiple seizure foci, not resectable focus because of eloquent cortex location, or inability to tolerate surgery due to ongoing concomitant medical conditions. Neurostimulation devices have provided possible seizure control for refractory epilepsy patients who are not candidates for surgical intervention. Among them, vagal nerve stimulation (VNS) has been the oldest, in use since 1997. VNS was followed by responsive nerve stimulation (RNS) after obtaining FDA approval in 2013. Deep brain stimulation (DBS) has not yet met approval in the USA, but has been in clinical practice in Europe since 2010. Neurostimulation devices vary in how they are inserted and their mechanisms of action. VNS has been easily accepted by patients since it is placed extracranially. By contrast, DBS and RNS require invasive procedures for intracranial implantation. As use of these devices will continue to increase in the foreseeable future, we aimed to contribute to the foundation for new research to expand on current knowledge and practice by reviewing the current status of the literature.
Literature
1.
• Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342:314–9. First widely accepted definition of medically refractory epilepsy, helping clinicians when to consider surgical treatment for patients with epilepsy. That study has been accepted as practice parameter since then.CrossRefPubMed
2.
3.
Surges R, Sander JW. Sudden unexpected death in epilepsy: mechanisms, prevalence, and prevention. Curr Opin Neurol. 2012;25(2):201–7.CrossRefPubMed
4.
• Wiebe S, Blume WT, Girvin JP, Eliasziw M, Group E and E of S for TLES. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345:311–8. Key study to compare surgical treatment to medical treatment in patients with refractory temporal lobe epilepsy.CrossRefPubMed
5.
6.
Davis R, Emmonds SE. Cerebellar stimulation for seizure control: 17-year study. Stereotact Funct Neurosurg. 1992;58:200–8.CrossRefPubMed
7.
Wright GD, McLellan DL, Brice JG. A double-blind trial of chronic cerebellar stimulation in twelve patients with severe epilepsy. J Neurol Neurosurg Psychiatry. 1984;47:769–74.CrossRefPubMedPubMedCentral
8.
Fernández-Guardiola A, Martinez A, Valdés-Cruz A, et al. Vagus nerve prolonged stimulation in cats: effects on epileptogenesis (amygdale electrical kindling): behavioral and electrographic changes. Epilepsia. 1999;40:822–9.CrossRefPubMed
9.
Henry TR, Votaw JR, Pennell PB, et al. Acute blood flow changes and efficacy of vagus nerve stimulation in partial epilepsy. Neurology. 1999;52:1166–73.CrossRefPubMed
10.
Nichols JA, Nichols AR, Smirnakis SM, et al. Vagus nerve stimulation modulates cortical synchrony and excitability through the activation of muscarinic receptors. Neuroscience. 2011;189:207–14.CrossRefPubMed
11.
Berridge CW, Foote SL. Effects of locu coeruleus activation on electroencephalographic activity in neocortex and hippocampus. J Neurosci. 1991;11:3135–45.PubMedPubMedCentral
12.
•• The Vagus Nerve Stimulation Study Group. A randomized controlled trial of chronic vagus nerve stimulation for the treatment of medically intractable seizures. Neurology. 1995;45:224–30. Initial landmark clinical trial for use of VNS in patients with refractory epilepsy, also known as EO3 study, comparing high-frequency to low-frequency VNS output currents.CrossRef
13.
•• Handforth A, Degiorgio CM, Schacter S, et al. Vagus nerve stimulation therapy for partial-onset seizures: a randomized active-control trial. Neurology. 1998;51:48–55. Second clinical study of use of VNS in patients with refractory epilepsy, also known as EO5, comparing high-frequency versus low-frequency VNS output currents for longer period follow up to 5 years.CrossRefPubMed
14.
Kuba R, Brazdil M, Kalina M, et al. Vagus nerve stimulation: longitudinal follow-up of patients treated for 5 years. Seizure. 2009;18:269–74.CrossRefPubMed
15.
Soss J, Heck C, Murray D, et al. A prospective longterm study of external trigeminal nerve stimulation for drug-resistant epilepsy. Epilepsy Behav. 2015;42:44–7.CrossRefPubMed
16.
Ben-Menachem E. Vagus nerve stimulation, side effects, and long-term safety. J Clin Neurophysiol. 2001;18:415–8.CrossRefPubMed
17.
Cooper IS, Upton AR, Amin I. Reversibility of chronic neurologic deficits. Some effects of electrical stimulation of the thalamus and internal capsule in man. Appl Neurophysiol. 1980;43:244–58.PubMed
18.
Mirski MA, Fisher RS. Electrical stimulation of the mammillary nuclei increases seizure threshold to pentylenetetrazol in rats. Epilepsia. 1994;35:1309–16.CrossRefPubMed
19.
Mirski MA, Rossell LA, Terry JB, et al. Anticonvulsant effect of anterior thalamic high frequency electrical stimulation in the rat. Epilepsy Res. 1997;28:89–100.CrossRefPubMed
20.
Moeller F, Siebner HR, Wolff S, et al. Changes in activity of striato-thalamo-cortical network precede generalized spike wave discharges. Neuroimage. 2008;39:1839–49.CrossRefPubMed
21.
Tyvaert L, Chassagnon S, Sadikot A, et al. Thalamic nuclei activity in idiopathic generalized epilepsy: an EEG-fMRI study. Neurology. 2009;73:2018–22.CrossRefPubMed
22.
•• Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of the thalamus for treatment of refractory epilepsy. Epilepsia. 2010;51:899–908. This is landmark study to show efficacy of DBS in treatment of medically refractory epilepsy via stimulation of anterior nucleus of thalamus.CrossRefPubMed
23.
Penfield W, Jasper H. Electrocorticography. In: Penfield W, Jasper H, editors. Epilepsy and the functional anatomy of the human brain. Boston: Little, Brown; 1954. p. 692–738.
24.
Kossoff EH, Ritzl EK, Politsky JM, et al. Effect of an external responsive neurostimulation on seizures and electrographic discharges during subdural electrode monitoring. Epilepsia. 2004;45:1560–7.CrossRefPubMed
25.
Kinoshita M, Ikeda A, Matsumoto R, et al. Electric stimulation on human cortex suppresses fast cortical activity and epileptic spikes. Epilepsia. 2004;45(7):787–91.CrossRefPubMed
26.
Van Buren JM, Wood JH, Oakley J, Hambrecht F. Preliminary evaluation of cerebellar stimulation by double-blind stimulation and biological criteria in the treatment of epilepsy. J Neurosurg. 1978;48:407–16.CrossRefPubMed
27.
Kinoshita M, Ikeda A, Matsuhashi M, et al. Electric cortical stimulation suppresses epileptic and background activities in neocortical epilepsy and mesial temporal lobe epilepsy. Clin Neurophysiol. 2005;116(6):1291–9.CrossRefPubMed
28.
Sohal VS, Sun FT. Responsive neurostimulation suppresses synchronized cortical rhythms in patients with epilepsy. Neurosurg Clin N Am. 2011;22:481–8.CrossRefPubMed
29.
D’Arcangelo G, Panuccio G, Tancredi V, Avoli M. Repetitive lowfrequency stimulation reduces epileptiform synchronization in limbic neuronal networks. Neurobiol Dis. 2005;19(1–2):119–28.CrossRefPubMed
30.
•• Morrell MJ, RNS System in Epilepsy Study Group. Responsive cortical stimulation for the treatment of medically intractable partial seizures. Neurology. 2011;77:1295–304. First and key study of RNS in treatment of medically refractory epilepsy, while results of this study lead to FDA approval.CrossRefPubMed
31.
Heck CN, King-Stephens D, Massey AD, et al. Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS system pivotal trial. Epilepsia. 2014;55(3):432–41.CrossRefPubMedPubMedCentral
Metadata
Title
Neurostimulation Devices Used in Treatment of Epilepsy
Author
Evren Burakgazi Dalkilic, MD
Publication date
01-02-2017
Publisher
Springer US
Published in
Current Treatment Options in Neurology / Issue 2/2017
Print ISSN: 1092-8480
Electronic ISSN: 1534-3138
DOI
https://doi.org/10.1007/s11940-017-0442-9