Chapter 52 - Cerebellar Stimulation for Epilepsy

Abstract

This chapter focuses on the application of cerebellar stimulation in the treatment of epilepsy. The cerebellum can be divided into the flocculonodular, anterior, and posterior lobes. Functional divisions include the vermis, the intermediate zone, and the lateral zone. The flocculonodular lobe coordinates balance and eye movements and the anterior cerebellum is involved in muscle tone and proprioception via the spinocerebellar tracts. Cerebellar stimulation has been previously reported in the treatment of cerebral palsy, spasticity, dystonia, and epilepsy. Pioneering work in the area of cerebellar stimulation began with animal studies that demonstrated that stimulation of the anterior vermis leads to an inhibition of decerebrate rigidity. The animal studies on EEG suppression were confirmed in a human trial that demonstrated that stimulation of the cerebellar dentate nucleus suppressed the subclinical epileptic discharges from intracerebral electrode. For instance, it was demonstrated that stimulation of the cerebellar dentate nucleus suppressed subclinical epileptic discharges on EEG recordings from intracerebral electrodes and correlated with the reduction of the frequency of generalized, complex partial, and secondary generalized seizures. The most common method of electrodes placement is via two suboccipital burr holes, as opposed to a suboccipital craniotomy for exposure of the posterior fossa and the most common placement of electrodes is the superomedial cerebellar cortex.