79 - Electrical Stimulation for Epilepsy (VNS, DBS, and RNS)

Abstract

Electrical stimulation of the brain provides a nondestructive alternative for the 30% to 40% of patients who have not attained seizure freedom with medications alone, and who are not candidates for brain resection or ablation. Facilitated by advances in technology, there is an increasing array of neurostimulation approaches available. Vagus nerve stimulation (VNS) has been most frequently used, mediating its effects through modulation of several brain networks, and now is available with triggering by detection of ictal tachycardia. Deep brain stimulation (DBS) of various targets has been explored, the most promising of which is anterior thalamic DBS that modifies brain networks involved primarily in limbic epilepsy. Direct stimulation of the seizure onset zone is equally as effective, an approach used by responsive neurostimulation (RNS), in which stimulation is triggered by detection of epileptic activity from continuous electrocorticography. Despite the success of brain stimulation in significantly reducing seizure frequency, it has not yet yielded high rates of seizure freedom. New approaches using closed-loop control of epileptic networks hold promise for further improvements in brain modulation for refractory epilepsy.