Stimulating Solutions for Intractable Epilepsy

Abstract

Implantable devices for controlling medically intractable seizures nondestructively are rapidly advancing. These offer reversible, potentially, restorative options beyond traditional, surgical procedures, which rely, largely on resection or ablation of selected brain sites. Several lines of, investigation aimed at improving efficacy of these devices are discussed, ranging from identifying novel subcortical, white matter, or cell-type specific targets to engineering advances for adaptive techniques based- on continuous, dynamic system analysis.

Keywords: electrical stimulation; epileptic networks; intractable epilepsy; next-generation devices; therapeutic devices.

Figure 1.

Brain co-processer for integrating implanted sensing and stimulation devices with off-the-body computing resources. The system enables continuous tracking of physiological data coupled with adaptive electrical stimulation. Top) Schematic for bidirectional data transmission between implanted brain sensing and stimulation device integrated with local handheld computer (Epilepsy Patient Assist Device) and cloud environment. The integrated system provides a platform for real-time, continuous, remote ambulatory monitoring physiological data such as brain behavioral state (wake, sleep, and seizures), biomarker (eg, interictal discharges) and behavior (patient inputs, actigraphy, mood, memory), as well as device data (eg, battery status and telemetry). Bottom left) The electrophysiology data are wirelessly telemetered off the implant and processed. Bottom right) Web-based Epilepsy Dashboard enables review of immediate and long-term data trends from the device (eg, battery, electrode impedances), electrophysiology data, and patient inputs. The physician can quickly review and either confirm or reject automatically detected and patient-reported events.