[Treatment of pharmacoresistant epilepsy: stimulated refractoriness].
Antiepileptic drugs allow controlling seizures in 70% of patients. For the others, a presurgical work-up should be undertaken, especially if a focal seizure origin is suspected; however, only a fraction of pharmacoresistant patients will be offered resective (curative) surgery. In the last 15 years, several palliative therapies using extra- or intracranial electrical stimulations have been developed. This article presents the vagal nerve stimulation, the deep brain stimulation (targeting the mesiotemporal region or the thalamus), and the cortical stimulation "on demand". All show an overall long-term responder rate between 30-50%, but less than 5% of patients becoming seizure free. It is to hope that a better understanding of epileptogenic mechanisms and of the implicated neuronal networks will lead to an improvement of these proportions.
Service de neurologie, CHUV, 1011 Lausanne. andrea.rossetti@chuv.ch
Andrea O
AO
Rossetti
Serge
S
Vulliémoz
D000927:Anticonvulsants / Q000627:therapeutic use*; D046690:Deep Brain Stimulation / Q000379:methods / Q000706:statistics & numerical data; D004351:Drug Resistance / Q000502:physiology*; D004558:Electric Stimulation / Q000379:methods*; D004827:Epilepsy / Q000188:drug therapy*; D006801:Humans; D019635:Neurosurgical Procedures; D017211:Treatment Failure; D055536:Vagus Nerve Stimulation / Q000379:methods / Q000706:statistics & numerical data
D000927:Anticonvulsants