Possible new avenues in epilepsy treatment: the stimulation techniques Deep brain stimulation, vagal nerve stimulation, transcranial magnetic stimulation

Summary Stimulation techniques have been extensively explored as new treatments for epilepsy, and their efficacy is still being investigated, albeit several approaches appear to be very promising. Vagal nerve stimulation (VNS) has been a well established palliative therapy for almost 20 years, however, complete seizure control is rarely obtained. Its favourable effect on mood has been noted in several studies, and VNS was FDA-approved for the treatment of major depression in 2005. Intracerebral electrical stimulation is currently being evaluated as ap otential treatment for patients with drug-resistan tf ocal epilepsy in whom surgery cannot be offered. We summarise the results of various studies applying deep brain stimulation (DBS) to different brain structures, particularly to the mesial temporal lobe. From these studies, it appears that the efficiency of DBS to reduce epileptic seizures is demonstrated in a sufficiently large patient population but the exact determinants (physical parameters, syndromes) of its success (or its absence) remain unknown. Repetitive Transcranial Magnetic Stimulation (rTMS) has been investigated as an antiepileptic treatment in patients with focal seizure onset by several groups, however, the clinical success is variable and in most studies rather low.