Neuromodulation for the Treatment of Epilepsy: A Review of Current Approaches and Future Directions

Purpose: Neuromodulation holds great promise for the treatment of drug-resistant epilepsy. This article reviews the most common types of neuromodulation as well as potential future applications of preclinical techniques such as optogenetics. This review serves as a reference for treating neurologists on the latest science behind such treatment approaches. Methods: This narrative review briefly describes the preclinical and clinical history of each technique, with a special emphasis on, wherever possible, strong clinical evidence and any available data from pediatric populations. A detailed literature review was performed for each method of neuromodulation. Findings: Since the concept of electrical stimulation as a treatment for neurologic conditions emerged in the early 19th century, neuromodulatory techniques using direct or induced electrical currents have been developed to reduce seizure frequency and duration in patients with drug-resistant epilepsy. This article reviews the applications, clinical guidelines, outcomes, and proposed mechanisms of available approaches, including vagus nerve stimulation, responsive neurostimulation, deep brain stimulation, and transcranial stimulation. Although promising outcomes have been achieved in adults and children with drug-resistant epilepsy, heterogeneity among epilepsy types and etiologies, optimization of stimulation parameters, and a lack of direct comparisons between neuromodulatory approaches are challenges that have yet to be overcome. (C) 2020 Elsevier HS Journals, Inc.