Brain stimulation for surgical epilepsy

Direct brain stimulation is an emerging treatment of epilepsy especially in patients that are not candidates for epilepsy surgery. Several different approaches of brain stimulation in epilepsy have been developed: stimulation is applied to interrupt epileptic networks in subcortical structures or a stimulus is directly applied to the seizure onset zone. Scheduled stimulation targets mainly subcortical structures like the anterior thalamic nucleus or the centromedian nucleus of the thalamus. The anterior nucleus of the thalamus was studied in a randomized trial in humans. Several case series reported reduction of seizures targeting other subcortical structures. Scheduled stimulation of the seizure onset zone in the hippocampus has also been shown to be safe and effective in a small number of patients. The application of electrical pulses to test for certain brain functions has long been established for the purposes of brain mapping. Traditionally stimulation at 50Hz for several seconds has been used. This stimulus frequently causes afterdischarges or seizures. Afterdischarges can be terminated by applying a very brief stimulus at the same frequency. Responsive stimulation is based on detection on this principle. Seizures are recorded intracranially and a high-frequency pulse applied whenever seizures evolve electrically. An automated implanted device for seizures detection and stimulation has been developed and shown to be safe for human use. A large clinical trial is currently ongoing. In conclusion, the optimal target and mode of stimulation for the treatment of epilepsy remains under investigation and requires large and costly controlled trials.

[1]  Clement Hamani,et al.  Deep brain stimulation of the anterior nucleus of the thalamus: Effects of electrical stimulation on pilocarpine-induced seizures and status epilepticus , 2008, Epilepsy Research.

[2]  Ana Luisa Velasco,et al.  Double‐blind, Randomized Controlled Pilot Study of Bilateral Cerebellar Stimulation for Treatment of Intractable Motor Seizures , 2005, Epilepsia.

[3]  R. Lesser,et al.  Brief bursts of pulse stimulation terminate afterdischarges caused by cortical stimulation , 1999, Neurology.

[4]  Cerebellar nuclear stimulation in generalized penicillin epilepsy , 1976, Brain Research Bulletin.

[5]  R. Post,et al.  Quenching: inhibition of development and expression of amygdala kindled seizures with low frequency stimulation. , 1995, Neuroreport.

[6]  S A Chkhenkeli,et al.  Effects of therapeutic stimulation of nucleus caudatus on epileptic electrical activity of brain in patients with intractable epilepsy. , 1997, Stereotactic and functional neurosurgery.

[7]  S. Taylor,et al.  Deep brain stimulation for refractory obsessive-compulsive disorder , 2005, Biological Psychiatry.

[8]  Kristl Vonck,et al.  Electrical stimulation for the treatment of epilepsy , 2009, Neurotherapeutics.

[9]  Clement Hamani,et al.  Bilateral Anterior Thalamic Nucleus Lesions and High-frequency Stimulation Are Protective against Pilocarpine-induced Seizures and Status Epilepticus , 2004, Neurosurgery.

[10]  Dirk Van Roost,et al.  Deep Brain Stimulation in Patients with Refractory Temporal Lobe Epilepsy , 2007, Epilepsia.

[11]  M. Velasco,et al.  Electrical Stimulation of the Hippocampal Epileptic Foci for Seizure Control: A Double‐Blind, Long‐Term Follow‐Up Study , 2007, Epilepsia.

[12]  Ingram Wright,et al.  High frequency stimulation of the mamillothalamic tract for the treatment of resistant seizures associated with hypothalamic hamartoma , 2009, Epilepsia.

[13]  Robert S Fisher,et al.  Anticonvulsant effect of anterior thalamic high frequency electrical stimulation in the rat , 1997, Epilepsy Research.

[14]  T J Ebner,et al.  Effects of cerebellar stimulation on unitary activity within a chronic epileptic focus in a primate. , 1980, Electroencephalography and clinical neurophysiology.

[15]  Philippe Kahane,et al.  Deep brain stimulation in epilepsy with particular reference to the subthalamic nucleus. , 2002, Epileptic disorders : international epilepsy journal with videotape.

[16]  F. Lado,et al.  Chronic Bilateral Stimulation of the Anterior Thalamus of Kainate‐treated Rats Increases Seizure Frequency , 2006, Epilepsia.

[17]  S. Wiebe,et al.  Hippocampal electrical stimulation in mesial temporal lobe epilepsy , 2006, Neurology.

[18]  R A Wennberg,et al.  Long-term follow-up of patients with thalamic deep brain stimulation for epilepsy , 2006, Neurology.

[19]  Ivan Osorio,et al.  High Frequency Thalamic Stimulation for Inoperable Mesial Temporal Epilepsy , 2007, Epilepsia.

[20]  Christian Raftopoulos,et al.  Absence of memory dysfunction after bilateral mammillary body and mammillothalamic tract electrode implantation: preliminary experience in three patients. , 2005, AJNR. American journal of neuroradiology.

[21]  H. Jasper.  Current evaluation of the concepts of centrencephalic and cortico-reticular seizures. , 1991, Electroencephalography and clinical neurophysiology.

[22]  P. Nádvorník,et al.  Central stimulation treatment of epilepsy. , 1980, Acta neurochirurgica. Supplementum.

[23]  M Velasco,et al.  Electrical Stimulation of the Centromedian Thalamic Nucleus in the Treatment of Convulsive Seizures: A Preliminary Report , 1987, Epilepsia.

[24]  Miron Šramka,et al.  Electrophysiological effects and clinical results of direct brain stimulation for intractable epilepsy , 2004, Clinical Neurology and Neurosurgery.

[25]  M. Stern,et al.  Deep brain stimulation in Parkinson disease: a metaanalysis of patient outcomes. , 2005, Journal of neurosurgery.

[26]  Giuseppe Messina,et al.  Deep Brain Stimulation of Two Unconventional Targets in Refractory Non-Resectable Epilepsy , 2008, Stereotactic and Functional Neurosurgery.

[27]  K. Gale,et al.  Subcortical structures and pathways involved in convulsive seizure generation. , 1992, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[28]  T E Peters,et al.  Network System for Automated Seizure Detection and Contingent Delivery of Therapy , 2001, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[29]  Brian Litt,et al.  Electrical Stimulation of the Anterior Nucleus of the Thalamus for the Treatment of Intractable Epilepsy , 2004, Epilepsia.

[30]  A R Upton,et al.  Suppression of seizures and psychosis of limbic system origin by chronic stimulation of anterior nucleus of the thalamus. , 1985, International journal of neurology.

[31]  M Velasco,et al.  Effect of Chronic Electrical Stimulation of the Centromedian Thalamic Nuclei on Various Intractable Seizure Patterns: I. Clinical Seizures and Paroxysmal EEG Activity , 1993, Epilepsia.

[32]  L. Velíšek,et al.  The Effect of Electrical Stimulation of the Subthalamic Nucleus on Seizures Is Frequency Dependent , 2003, Epilepsia.

[33]  R P Lesser,et al.  Placebo‐Controlled Pilot Study of Centromedian Thalamic Stimulation in Treatment of Intractable Seizures , 1992, Epilepsia.

[34]  H. Lüders,et al.  Deep Brain Stimulation in Epilepsy , 2001, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[35]  Joshua Rosenow,et al.  Irving S. Cooper and His Role in Intracranial Stimulation for Movement Disorders and Epilepsy , 2003, Stereotactic and Functional Neurosurgery.

[36]  William H Theodore,et al.  Brain stimulation for epilepsy. , 2007, Acta neurochirurgica. Supplement.

[37]  J. V. Van Buren,et al.  Preliminary evaluation of cerebellar stimulation by double-blind stimulation and biological criteria in the treatment of epilepsy. , 1978, Journal of neurosurgery.

[38]  S Gilman,et al.  The effect of chronic cerebellar stimulation upon epilepsy in man. , 1973, Transactions of the American Neurological Association.

[39]  Lorella Minotti,et al.  Antiepileptic Effect of High-frequency Stimulation of the Subthalamic Nucleus (Corpus Luysi) in a Case of Medically Intractable Epilepsy Caused by Focal Dysplasia: A 30-month Follow-up: Technical Case Report , 2002, Neurosurgery.

[40]  Philippe Kahane,et al.  Manipulating the epileptic brain using stimulation: a review of experimental and clinical studies. , 2009, Epileptic disorders : international epilepsy journal with videotape.

[41]  W. Goodman,et al.  Deep brain stimulation for refractory obsessive-compulsive disorder. , 2009, Frontiers in bioscience.

[42]  S. Rothman,et al.  The therapeutic potential of focal cooling for neocortical epilepsy , 2009, Neurotherapeutics.

[43]  D. Spencer,et al.  Effect of an External Responsive Neurostimulator on Seizures and Electrographic Discharges during Subdural Electrode Monitoring , 2004, Epilepsia.

[44]  Tony Wu,et al.  Electrical Stimulation of the Anterior Nucleus of the Thalamus for Intractable Epilepsy: A Long‐term Follow‐up Study , 2007, Epilepsia.

[45]  M. Velasco,et al.  Neuromodulation of the Centromedian Thalamic Nuclei in the Treatment of Generalized Seizures and the Improvement of the Quality of Life in Patients with Lennox–Gastaut Syndrome , 2006, Epilepsia.

[46]  D. Mclellan,et al.  A double-blind trial of chronic cerebellar stimulation in twelve patients with severe epilepsy. , 1984, Journal of neurology, neurosurgery, and psychiatry.

[47]  Sabine Rona,et al.  Chronic High‐Frequency Deep Brain Stimulation of the STN/SNr for Progressive Myoclonic Epilepsy , 2007, Epilepsia.

[48]  Ivan Osorio,et al.  Automated seizure abatement in humans using electrical stimulation , 2005, Annals of neurology.

[49]  R. Lesser,et al.  Optimizing Parameters for Terminating Cortical Afterdischarges with Pulse Stimulation , 2002, Epilepsia.

[50]  I. Cooper,et al.  Chronic cerebellar stimulation in epilepsy. Clinical and anatomical studies. , 1976, Archives of neurology.