Neurostimulation. A promising therapeutic option for medically refractory epilepsy

Abstract

Epilepsy is a common and serious chronic neurological disorder, affecting around 65 million people worldwide. Despite the advances in pharmacologic treatments for epilepsy, approximately 30% of the patients remain medically refractory and continue to have seizures on medications, in such cases, other treatment approaches are necessary. Resection surgery can be an alternative in many patients to achieve good seizure control; however, not all patients are suitable candidates for surgery. Electrical stimulation of the brain is a rapidly evolving therapy for patients with uncontrolled seizures despite the best medical and surgical treatment. Vagus nerve stimulation, deep brain stimulation of the anterior nucleus of thalamus, and responsive neurostimulation have class I evidence supporting their use in patients with intractable epilepsy. In this review, we discuss the evidence of these therapeutic modalities, their mechanism of action, efficacy, outcome, and their application in clinical use.