Will the new antiseizure devices fill the gap between drugs and surgery? Treating the brain as a “black box”

Abstract

An informed answer to the question Will the new antiseizure devices fill the gap between drugs and surgery? requires that the therapeutic ratio and the devices’ capacity to cost-effectively decrease disease burden globally be considered. Regarding therapeutic ratio, the answer is likely Yes, if and only if, and at a minimum, all relevant seizure variables are quantified, the spatiotemporal behavior of seizures at short and long time scales is better understood, and statistical analyses of efficacy conform to and address the multidimensional, complex nature of seizures. Regarding the capacity of devices to cost-effectively decrease disease burden globally, the answer is likely No, unless: (1) cost-effectiveness is demonstrable and maximal, which requires that devices become the sole therapy; (2) seizure comorbidities are prevented or their seriousness is reduced; (3) patients with pharmacoresistant seizures may rejoin society's mainstream; and (4) disruptive (revolutionary) conceptual and technological advances materialize.