Disrupting abnormal electrical activity with deep brain stimulation: is epilepsy the next frontier?
Given the tremendous success of deep brain stimulation (DBS) for the treatment of movement and neuropsychiatric disorders, clinicians have begun to open up to the possible use of electrical stimulation for the treatment of patients with uncontrolled seizures. This process has resulted in the discovery of a wide array of DBS targets, including the cerebellum, hypothalamus, hippocampus, basal ganglia, and various thalamic nuclei. Despite the ambiguity of the mechanism of action and the unknowns surrounding potentially ideal stimulation settings, several recent trials have empirically demonstrated reasonable efficacy in selected cases of medication-refractory seizures. These exciting results have fueled a number of studies aimed at firmly establishing DBS as an effective treatment for selected cases of intractable epilepsy, and many companies are aiming at Food and Drug Administration approval. We endeavor to review the studies in the context of the various DBS targets and their relevant circuitry for epilepsy. Based on the unfolding research, DBS has the potential to play an important role in treating refractory epilepsy. The challenge, as in movement disorders, is to assemble interdisciplinary teams to screen, implant, and follow patients, and to clarify patient selection. The future will undoubtedly be filled with optimization of targets and stimulation parameters and the development of best practices. With tailored therapeutic approaches, epilepsy patients have the potential to improve with DBS.
Rahman
Maryam
M
Department of Neurosurgery, University of Florida, Gainesville, Florida, USA. maryam.rahman@neurosurgery.ufl.edu
Abd-El-Barr
Muhammad M
MM
Vedam-Mai
Vinata
V
Foote
Kelly D
KD
Murad
Gregory J A
GJ
Okun
Michael S
MS
Roper
Steven N
SN
D001921:Brain / Q000503:physiopathology*; D046690:Deep Brain Stimulation / Q000379:methods* / Q000639:trends; D004351:Drug Resistance; D004569:Electroencephalography / Q000706:statistics & numerical data; D004827:Epilepsy / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D005544:Forecasting; D006801:Humans; D018579:Patient Selection; D016896:Treatment Outcome