4.5 Review

Practical considerations in epilepsy neurostimulation

Related references

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Summary: This study demonstrates the safety and efficacy of multifocal, personalized, multichannel cathodal transcranial direct current stimulation in reducing seizure frequency in patients with drug-resistant focal epilepsy. However, there is a possibility of seizure exacerbation in some patients.

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Summary: In this study, deep brain stimulation to the centromedian thalamic nucleus (CM-DBS) was found to reduce electrographic seizures in patients with Lennox-Gastaut syndrome (LGS), with 50% of participants experiencing a >= 50% reduction in diary-recorded seizures after 3 months of stimulation.

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Summary: This study investigates the efficacy of cathodal high-definition tDCS as a noninvasive treatment for drug-resistant focal epilepsy. The results demonstrate that cathodal HD-tDCS significantly reduces seizure frequency and interictal epileptiform discharges, improves quality of life, and holds promise as a treatment modality for patients with drug-resistant focal epilepsy. Further research is needed to define the optimal stimulation parameters.

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Summary: This study investigated the long-term effects of personalized, multisession, stereotactic-EEG (SEEG)-targeted multichannel tDCS on seizure frequency (SF) and functional connectivity (Fc) in patients with drug-resistant epilepsy. The results showed that after the treatment, five patients experienced a significant decrease in seizure frequency, and functional connectivity was also found to decrease in patients with a significant response.

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Summary: This study examined the effects of 1 Hz motor cortex stimulation using repetitive magnetic stimulation (rTMS) on cortical activity. The findings showed a reduction in the P60 peak and an increase in the N100 peak after 1 Hz rTMS, suggesting enhanced slow inhibition. TMS-EEG may serve as a useful biomarker for evaluating brain excitability, but individual responses are highly variable and distinguishing merged peaks can be challenging.

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Case Report: Prolonged Effects of Short-Term Transcranial Magnetic Stimulation on EEG Biomarkers, Spectral Power, and Seizure Frequency

Keith Starnes et al.

Summary: Transcranial magnetic stimulation (TMS) is an effective and well-tolerated non-invasive method for controlling refractory epilepsy, with potential to guide treatment based on changes in EEG biomarkers. This case demonstrates the efficacy of low-frequency repetitive TMS (rTMS) in reducing seizure frequency and the association between EEG biomarkers and seizure control.

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Experience and consensus on stimulation of the anterior nucleus of thalamus for epilepsy

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Summary: Deep brain stimulation of the anterior nuclei of thalamus (ANT-DBS) is effective for reducing seizures in patients with temporal or frontal epilepsy refractory to at least two medications. Motivations for therapy renewal upon battery depletion include reduced seizures, improved quality of life, and reduction of severe seizures. Stimulation parameters are mainly guided by magnetic resonance imaging and typically follow parameters similar to the SANTE study, with initial stimulation amplitudes in the 2-3 V or mA range.

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Centromedian thalamic nucleus with or without anterior thalamic nucleus deep brain stimulation for epilepsy in children and adults: A retrospective case series

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Transcutaneous Vagus Nerve Stimulation (t-VNS) and epilepsy: A systematic review of the literature

Marios Lampros et al.

Summary: Transcutaneous auricular vagus nerve stimulation (t-VNS) as an alternative method for treating neurological and psychiatric disorders was reviewed in this study for its efficacy, adverse effects, and technical features in epilepsy patients. The review included 10 studies with 350 patients, indicating a potential benefit of t-VNS for epilepsy patients, although no definite conclusions could be drawn due to study heterogeneity.

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Transcranial direct current stimulation (tDCS) in the management of epilepsy: A systematic review

Pedro Sudbrack-Oliveira et al.

Summary: This study conducted a systematic review on the application of transcranial direct current stimulation (tDCS) in patients with epilepsy, and the results indicate that cathodal tDCS may be a safe and effective technique for seizure control in patients with drug-resistant epilepsy. However, more and larger sham-controlled randomized trials are needed to further advance this treatment method.

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Vicenta Salanova et al.

Summary: This study evaluated the long-term efficacy and safety of deep brain stimulation (DBS) for epilepsy, showing favorable outcomes with stable results. Reduction in frequency of the most severe seizure type may lower the risk of SUDEP. The SUDEP rate with DBS (2.0) is comparable to other neuromodulation treatments for drug-resistant focal epilepsy.

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Summary: The study aimed to evaluate the feasibility of using full bandwidth chronic intracranial EEG data for ANT PIB-based seizure detection. The results showed that the best detector had a 7-Hz center frequency, 5-Hz band width, and 10-second epoch duration, demonstrating high sensitivity and low false alarm rates for some patients.

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