Different modalities of invasive neurostimulation for epilepsy
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REVIEW ARTICLE
Different modalities of invasive neurostimulation for epilepsy Soha A. Alomar 1
&
Rothaina J. Saeedi 1
Received: 8 April 2020 / Accepted: 19 July 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Epilepsy affects 1% of the general population, about one-third of which is pharmacologically resistant. Uncontrolled seizures are associated with an increased risk of traumatic injury and sudden unexpected death of epilepsy. There is a considerable psychological and financial burden on caregivers of patients with epilepsy, particularly among pediatric patients. Epilepsy surgery, when indicated, is the most promising cure for epilepsy. However, when surgery is contraindicated or refused by the patient, neurostimulation is an alternative palliative approach, albeit with a lower chance of entirely curing patients of seizures. There are many options for neurostimulation. The three most commonly used invasive neurostimulation procedures that consistently show evidence of being safe and efficacious are vagal nerve stimulation, responsive neuro stimulation, or anterior thalamic nucleus deep brain stimulation. The goal of this review is to summarize the current evidence supporting the use of these three techniques, which are approved by most regulatory bodies, and discuss different factors that may enable epilepsy surgeons to choose the most appropriate modality for each patient. Keywords Epilepsy . Seizure . Stimulation . NeuroPace . VNS . RNS
Introduction Epilepsy affects 1% of the general population, and about onethird of patients with epilepsy are pharmacologically resistant [1, 2]. In patients with uncontrolled seizures, there is a higher incidence of traumatic injuries and sudden unexpected death of epilepsy (SUDEP). Cengiz et al. studied seizure-related injuries, in 57 patients, 42 of whom sustained injuries, most frequently head injury (22%) and fractures (17%). Fifty-seven (64%) of the injuries occurred at home [3]. There is a significant psychological and financial burden on caregivers of patients with epilepsy, particularly among pediatric patients. In an interview with 60 parents of pediatric patients with epilepsy, Rani et al. found that 43.3% had restrained financial resources and 53.3% perceived negative reactions from others in response to their children’s illness, limiting family social
* Soha A. Alomar [email protected] Rothaina J. Saeedi [email protected] 1
Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia
interaction and resulting in emotional distress in the form of anger and depression [4]. When the seizure focus could be identified and did not overlap with eloquent cortex, surgical resection becomes the most effective strategy. Unfortunately, only 50% of patients who underwent a pre-surgical evaluation are eligible for surgery [5]. This led to the emergence of the concept of neurostimulation in the 1970s. Neurostimulation should not be considered a first option for medically re
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