title: Comparison of seizure control outcomes and the safety of vagus nerve, thalamic deep brain, and responsive neurostimulation: evidence from randomized controlled trials.
abstract: Epilepsy is a devastating disease, often refractory to medication and not amenable to resective surgery. For patients whose seizures continue despite the best medical and surgical therapy, 3 stimulation-based therapies have demonstrated positive results in prospective randomized trials: vagus nerve stimulation, deep brain stimulation of the thalamic anterior nucleus, and responsive neurostimulation. All 3 neuromodulatory therapies offer significant reductions in seizure frequency for patients with partial epilepsy. A direct comparison of trial results, however, reveals important differences among outcomes and surgical risk between devices. The authors review published results from these pivotal trials and highlight important differences between the trials and devices and their application in clinical use.
authors.affiliation: Department of Neurological Surgery, University of California at San Francisco, California 94143-0112, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Rolston
authors.forename: Dario J
authors.initials: DJ
authors.lastname: Englot
authors.forename: Doris D
authors.initials: DD
authors.lastname: Wang
authors.forename: Tina
authors.initials: T
authors.lastname: Shih
authors.forename: Edward F
authors.initials: EF
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D020643:Anterior Thalamic Nuclei / Q000502:physiology*; D002648:Child; D046690:Deep Brain Stimulation; D004567:Electrodes, Implanted; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000379:methods*; D055815:Young Adult