About this Research Topic
Epilepsy is a chronic neurological disorder frequently requiring lifelong treatment. In 70% of epilepsy patients, seizures are well controlled by anti epileptic medications. About 30% of epilepsy patients remain refractory to medical treatments and may need surgical interventions for better seizure control. Unfortunately, surgical intervention may not be feasible due to various reasons such as multiple seizure foci or a seizure onset in an eloquent cortex location. Neurostimulation devices have provided possible seizure control for refractory epilepsy patients who are not candidates for surgical intervention. Among them, vagal nerve stimulation (VNS) has been the oldest. VNS was followed by responsive nerve stimulation (RNS) and Deep brain stimulation (DBS) and well as more recent, less‐invasive therapies including transcranial direct current stimulation (tDCS) and Transcranial magnetic stimulation (TMS). All these therapies vary in their efficacy for seizure reduction, invasiveness and are associated with different side‐effect profiles. In addition, there exists a growing interest to improve technical aspects of these devices to optimize epilepsy treatment.
In the absence of head-to-head comparative trials with VNS, DBS and RNS, the results of the randomized controlled trials suggest that in choosing a therapy for unsuitable surgery candidates none of the neurostimulation options is superior with regards to efficacy. Differences in invasiveness and adverse events may therefore direct the choice between these options. Indeed, the choice of a specific type of neurostimulation results frequently from the personal experience of the clinician and practice at a specific epilepsy center.
The aim of this research topic is to describe how different stimulation modalities are used in specific epilepsy patients, highlight pitfalls in patient selection, explain the use of specific stimulation paradigms and contribute to the general understanding of mechanisms of action.
- Clinical research covering biomarkers of response to specific neurostimulation therapies
- Fundamental research covering mechanisms of action of VNS and DBS in animal models
- Case studies explaining specific stimulation protocols with RNS/DBS/TMS/TDCS
- Reviews covering clinical and fundamental aspects of neurostimulation for refractory epilepsy
- Novel methodological advancements with respect to neurostimulation devices, for example: incorporating new seizure detection and reporting techniques, new methodologies to target better intracerebral structures, MRI compatibility
- Responsive VNS
This research topic is open for different types of manuscripts: reviews, original research articles, case studies.
Keywords: Reafractory epilepsy, VNS, DBS, RNS, TMS
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