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

Flavia Venetucci Gouveia; Nebras M Warsi; Hrishikesh Suresh; Rafi Matin; George M Ibrahim

doi:10.1016/j.neurot.2023.e00308

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

Neurotherapeutics. 2024 Jan 4;21(3):e00308. doi: 10.1016/j.neurot.2023.e00308. Online ahead of print.

Authors

Flavia Venetucci Gouveia¹, Nebras M Warsi², Hrishikesh Suresh², Rafi Matin³, George M Ibrahim⁴

Affiliations

¹ Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada.
² Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada.
³ Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
⁴ Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada. Electronic address: george.ibrahim@sickkids.ca.

PMID: 38177025
DOI: 10.1016/j.neurot.2023.e00308

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).

Publication types

Review