Manipulating the epileptic brain using stimulation: a review of experimental and clinical studies.
Neurostimulation represents an interesting alternative therapy for patients resistant to drug treatment or who cannot benefit from resective surgery. Theoretically, neurostimulation allows the control of seizures to be tailored to the individual patient and specific form of epilepsy. Here, we review both experimental and clinical studies that have reported the possible control of epileptic seizures by means of different approaches using electrical stimulation (vagus nerve stimulation, deep brain stimulation and repetitive transcranial magnetic stimulation). The rationale for targeting specific areas that have thus far been considered (i.e., vagus nerve, cerebellum, anterior or centromedial thalamus, basal ganglia, cortex and temporal lobe) is addressed in the light of experimental data and clinical effectiveness in different models and forms of epilepsy. The type of seizures that can be considered for neurostimulation, as well as the optimal parameters such as stimulation frequency and modes of stimulation (chronic, continuous or adaptative), are discussed to determine the best candidates for such a therapeutic strategy. This review points out the need for improved knowledge of neural circuits that generate seizures and/or allow their propagation, as well as a better understanding of the mechanisms of action of neurostimulation.
Saillet
Sandrine
S
Institut des Neurosciences, INSERM U836-UJF-CEA, Grenoble, France.
Langlois
Mélanie
M
Feddersen
Berend
B
Minotti
Lorella
L
Vercueil
Laurent
L
Chabardès
Stephan
S
David
Olivier
O
Depaulis
Antoine
A
Deransart
Colin
C
Kahane
Philippe
P
D000818:Animals; D001479:Basal Ganglia / Q000503:physiopathology / Q000601:surgery; D001921:Brain / Q000503:physiopathology* / Q000601:surgery*; D002531:Cerebellum / Q000503:physiopathology / Q000601:surgery; D046690:Deep Brain Stimulation / Q000379:methods*; D004827:Epilepsy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D013788:Thalamus / Q000503:physiopathology / Q000601:surgery; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000379:methods*