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Review
. 2022 Dec 16;59(Suppl 1):S81-S90.
doi: 10.29399/npa.28181. eCollection 2022.

Beyond Resection: Neuromodulation and Minimally Invasive Epilepsy Surgery

Daniah Shamim  1 , Obiefuna Nwabueze  1 , Utku Uysal  1
Affiliations
Review

Beyond Resection: Neuromodulation and Minimally Invasive Epilepsy Surgery

Daniah Shamim et al. Noro Psikiyatr Ars. .

Abstract

Epilepsy is a common neurological disease impacting both patients and healthcare systems. Approximately one third of patients have drug-resistant epilepsy (DRE) and are candidates for surgical options. However, only a small percentage undergo surgical treatment due to factors such as patient misconception/fear of surgery, healthcare disparities in epilepsy care, complex presurgical evaluation, primary care knowledge gap, and lack of systemic structures to allow effective coordination between referring physician and surgical epilepsy centers. Resective surgical treatments are superior to medication management for DRE patients in terms of seizure outcomes but may be less palatable to patients. There have been major advancements in minimally invasive surgeries (MIS) and neuromodulation techniques that may allay these concerns. Both epilepsy MIS and neuromodulation have shown promising seizure outcomes while minimizing complications. Minimally invasive methods include Laser Interstitial Thermal Therapy (LITT), RadioFrequency Ablation (RFA), Stereotactic RadioSurgery (SRS). Neuromodulation methods, which are more palliative, include Vagus Nerve Stimulation (VNS), Deep Brain Stimulation (DBS), and Responsive Neurostimulation System (RNS). This review will discuss the role of these techniques in varied epilepsy subtypes, their effectiveness in improving seizure control, and adverse outcomes.

Keywords: Ablation; epilepsy surgery; minimally invasive epilepsy surgery; neuromodulation; seizure.

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Conflict of interest statement

Conflict of Interests: The authors declared that there is no conflict of interest

Figures

Figure 1
Figure 1
a–c. Left mesial temporal laser interstitial thermal therapy postoperative MRI coronal images. Immediate postoperative T2 coronal image (a). Four months postoperative T2 coronal image (b). Four months postoperative postcontrast T1MPRAGE image (c).
Figure 2
Figure 2
Postoperative coronal T2 MRI of radiofrequency ablation of left cingulate gyrus cortical tuber of a patient with Tuberous Sclerosis Complex and drug resistant epilepsy.
Figure 3
Figure 3
Coronal CT scout image of deep brain stimulator leads targeting bilateral anterior nucleus of the thalamus.
Figure 4
Figure 4
a, b. Coronal CT scout images of Responsive Neurostimulation System. Bilateral depth electrodes targeting bilateral hippocampus in a patient with bilateral mesial temporal epilepsy (a). Bilateral depth electrodes targeting bilateral supplementary motor area (b).
See this image and copyright information in PMC

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