[Invasive neurostimulation as adjunct treatment for epilepsy].
Neurostimulation techniques are applied to reduce the frequency and severity of epileptic seizures. Class I evidence showed that vagus nerve stimulation (VNS) reduces seizure burden by 25-28% compared to 6-15% in placebo controls. Open-label studies, however, reported much greater efficacy. Since 2010 deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) is CE approved for epilepsy therapy in Europe. A multicenter randomized controlled trial reported seizure frequency reduction by 40.4% compared to 14.5% in controls. A significant effect was only found in patients with temporal seizure onset. 13% of stimulated patients became seizure-free for at least 6 months. Possible side-effects include depression (14.8%) and memory impairment (13%). Responsive neurostimulation (RNS) combines an automated seizure detection device with on-demand triggered stimulation of the epileptogenic zone. A randomized controlled trial reported seizure frequency reduction by 37.9% compared to 17.3% in controls. There were no relevant neuropsychological or psychiatric side-effects noted.
Klinik für Epileptologie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Deutschland. Gabriel.moeddel@ukb.uni-bonn.de
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D046690:Deep Brain Stimulation / Q000379:methods* / Q000639:trends*; D004827:Epilepsy / Q000517:prevention & control* / Q000534:rehabilitation*; D019317:Evidence-Based Medicine; D006801:Humans; D016896:Treatment Outcome