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Review
. 2024 Apr;21(3):e00308.
doi: 10.1016/j.neurot.2023.e00308. Epub 2024 Jan 4.

Neurostimulation treatments for epilepsy: Deep brain stimulation, responsive neurostimulation and vagus nerve stimulation

Flavia Venetucci Gouveia  1 , Nebras M Warsi  2 , Hrishikesh Suresh  2 , Rafi Matin  3 , George M Ibrahim  4
Affiliations
Review

Neurostimulation treatments for epilepsy: Deep brain stimulation, responsive neurostimulation and vagus nerve stimulation

Flavia Venetucci Gouveia et al. Neurotherapeutics. 2024 Apr.

Abstract

Epilepsy is a common and debilitating neurological disorder, and approximately one-third of affected individuals have ongoing seizures despite appropriate trials of two anti-seizure medications. This population with drug-resistant epilepsy (DRE) may benefit from neurostimulation approaches, such as vagus nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS). In some patient populations, these techniques are FDA-approved for treating DRE. VNS is used as adjuvant therapy for children and adults. Acting via the vagus afferent network, VNS modulates thalamocortical circuits, reducing seizures in approximately 50 ​% of patients. RNS uses an adaptive (closed-loop) system that records intracranial EEG patterns to activate the stimulation at the appropriate time, being particularly well-suited to treat seizures arising within eloquent cortex. For DBS, the most promising therapeutic targets are the anterior and centromedian nuclei of the thalamus, with anterior nucleus DBS being used for treating focal and secondarily generalized forms of DRE and centromedian nucleus DBS being applied for treating generalized epilepsies such as Lennox-Gastaut syndrome. Here, we discuss the indications, advantages and limitations of VNS, DBS and RNS in treating DRE and summarize the spatial distribution of neuroimaging observations related to epilepsy and stimulation using NeuroQuery and NeuroSynth.

Keywords: Deep brain stimulation (DBS); Epilepsy; Neuroimaging meta analysis; Neurostimulation; Responsive neurostimulation; Vagus nerve stimulation (VNS).

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Illustration of the neurostimulation therapies used for treating drug-resistant epilepsy. A. The vagus nerve stimulation device comprises an electrode with three helical contacts connected to a subclavicular implantable pulse generator. B. The deep brain stimulation system comprises depth electrodes connected to a subclavicular implantable pulse generator. C. The responsive neurostimulation device comprises depth electrodes, cortical strips and a cranial implantable pulse generator.
Fig. 2
Fig. 2
Meta-analytic maps of neuroimaging findings. A. Maps generated using the term “Epilepsy”. B. Map generated using the terms “Epilepsy” and “Refractory”. C. Maps generated using the terms “Epilepsy”, “Stimulation” and “Vagus Nerve”. Maps were created on NeuroQuery [92,94] and NeuroSynth [93,95] and are shown on the MNI152 brain on the coronal plane [96].
See this image and copyright information in PMC

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