Epilepsy and Neuromodulation-Randomized Controlled Trials

Abstract

Neuromodulation is a treatment strategy that is increasingly being utilized in those suffering from drug-resistant epilepsy who are not appropriate for resective surgery. The number of double-blinded RCTs demonstrating the efficacy of neurostimulation in persons with epilepsy is increasing. Although reductions in seizure frequency is common in these trials, obtaining seizure freedom is rare. Invasive neuromodulation procedures (DBS, VNS, and RNS) have been approved as therapeutic measures. However, further investigations are necessary to delineate effective targeting, minimize side effects that are related to chronic implantation and to improve the cost effectiveness of these devices. The RCTs of non-invasive modes of neuromodulation whilst showing much promise (tDCS, eTNS, rTMS), require larger powered studies as well as studies that focus at better targeting techniques. We provide a review of double-blinded randomized clinical trials that have been conducted for neuromodulation in epilepsy.

Keywords: deep brain stimulation (DBS); epilepsy; external trigeminal nerve stimulation (eTNS); neuromodulation; randomized clinical trials (RCT); repetitive transcranial magnetic stimulation (rTMS); responsive neurostimulation (RNS); transcranial direct current stimulation (tDCS); vagal nerve stimulation (VNS).