Neurostimulation for Generalized Epilepsy: Should Therapy be Syndrome-specific?

Abstract

Current applications of neurostimulation for generalized epilepsy use a one-target-fits-all approach that is agnostic to the specific epilepsy syndrome and seizure type being treated. The authors describe similarities and differences between the 2 "archetypes" of generalized epilepsy-Lennox-Gastaut syndrome and Idiopathic Generalized Epilepsy-and review recent neuroimaging evidence for syndrome-specific brain networks underlying seizures. Implications for stimulation targeting and programming are discussed using 5 clinical questions: What epilepsy syndrome does the patient have? What brain networks are involved? What is the optimal stimulation target? What is the optimal stimulation paradigm? What is the plan for adjusting stimulation over time?

Keywords: Deep brain stimulation; Epilepsy; Generalized seizures; Idiopathic generalized epilepsy; Lennox-Gastaut syndrome; Neuromodulation; Responsive neurostimulation; Thalamus.