Deep brain stimulation in epilepsy: what is next?

Abstract

Experimental and clinical studies have suggested that epileptic seizures can be modulated or interrupted by electrical stimulations of subcortical structures that may exert a remote control on seizure generators. The aim of this review is to present these recent reports and to address the perspectives of this approach. The use of deep brain stimulation to control several motor diseases has renewed the interest of this technique for epilepsy. Several neurology and neurosurgery groups have applied this therapy to drug-resistant forms of epilepsy for which resective surgery cannot be applied. The choice of the subcortical brain structures that are targeted strongly depends on the rationale that has been developed from experimental studies using animal models. The stimulation parameters and whether deep brain stimulation for epilepsy must be continuously applied or only when a seizure occurs are a matter of debate. This article discusses the use of stimulation of the cerebellum, caudate nucleus, anterior and centromedian nucleus of the thalamus, subthalamic nucleus, and substantia nigra to treat epilepsy, in light of recent and less recent clinical and experimental data. New directions for studies are proposed for a better understanding of the mechanisms of action of this treatment.