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Deep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy
- Source :
- Neurosurgical Review
- Publication Year :
- 2019
-
Abstract
- Despite the use of first-choice anti-epileptic drugs and satisfactory seizure outcome rates after resective epilepsy surgery, a considerable percentage of patients do not become seizure free. ANT-DBS may provide for an alternative treatment option in these patients. This literature review discusses the rationale, mechanism of action, clinical efficacy, safety, and tolerability of ANT-DBS in drug-resistant epilepsy patients. A review using systematic methods of the available literature was performed using relevant databases including Medline, Embase, and the Cochrane Library pertaining to the different aspects ANT-DBS. ANT-DBS for drug-resistant epilepsy is a safe, effective and well-tolerated therapy, where a special emphasis must be given to monitoring and neuropsychological assessment of both depression and memory function. Three patterns of seizure control by ANT-DBS are recognized, of which a delayed stimulation effect may account for an improved long-term response rate. ANT-DBS remotely modulates neuronal network excitability through overriding pathological electrical activity, decrease neuronal cell loss, through immune response inhibition or modulation of neuronal energy metabolism. ANT-DBS is an efficacious treatment modality, even when curative procedures or lesser invasive neuromodulative techniques failed. When compared to VNS, ANT-DBS shows slightly superior treatment response, which urges for direct comparative trials. Based on the available evidence ANT-DBS and VNS therapies are currently both superior compared to non-invasive neuromodulation techniques such as t-VNS and rTMS. Additional in-vivo research is necessary in order to gain more insight into the mechanism of action of ANT-DBS in localization-related epilepsy which will allow for treatment optimization. Randomized clinical studies in search of the optimal target in well-defined epilepsy patient populations, will ultimately allow for optimal patient stratification when applying DBS for drug-resistant patients with epilepsy.
- Subjects :
- Drug Resistant Epilepsy
VAGUS NERVE-STIMULATION
Deep brain stimulation
Complications
Efficacy
medicine.medical_treatment
Review
Cochrane Library
Bioinformatics
REFRACTORY EPILEPSY
CONTROLLED-TRIAL
Anterior nucleus of the thalamus
030218 nuclear medicine & medical imaging
ACTIVATION
03 medical and health sciences
Epilepsy
DOUBLE-BLIND
0302 clinical medicine
NEURONAL APOPTOSIS
Thalamus
Mechanisms
TEMPORAL-LOBE EPILEPSY
Medicine
Humans
Epilepsy surgery
Neuropsychological assessment
medicine.diagnostic_test
business.industry
SEIZURE CONTROL
General Medicine
ELECTRICAL-STIMULATION
CEREBELLAR STIMULATION
medicine.disease
Neuromodulation (medicine)
Tolerability
nervous system
Surgery
Neurology (clinical)
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- ISSN :
- 03445607
- Volume :
- 42
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Neurosurgical Review
- Accession number :
- edsair.doi.dedup.....acff313d661454fc85f10886d7d0d361