[Deep brain stimulation for epilepsy]

Abstract

Despite the advances in pharmacologic treatments for epilepsy, approximately one-third of patients with epilepsy continue to have seizures, and alternative treatment approaches are necessary in such cases. For many patients, resective surgery can be an alternative for achieving seizure freedom; however, its success depend on identifying seizure foci before surgery. Many patients with medically intractable epilepsy are not suitable candidates for surgery. The therapeutic effect of electrical stimulation on the brain has been studied for decades. Currently, the thalamus, subthalamic nucleus, hippocampus, cerebellar nuclei, and cortical seizure foci are stimulated for treating epilepsy. In 2010, the results of the first, multicenter randomized double-blinded controlled study were published. This report documents a clinical trial involving stimulation of the anterior nucleus of the thalamus for epilepsy (SANTE). These results showed bilateral stimulation of the anterior nucleus of the thalamus reduces seizures. The responsive neurostimulator, which can be called a brain pacemaker, is another stimulation device for the treatment of epilepsy. A clinical trial involving the Neuropace system is in progress in the USA. Preliminary results indicating the efficacy of the Neuropace study were presented at the annual American Epilepsy Society meeting in 2010; the final results of this study are awaited.