Neurostimulation for treatment of drug- resistant epilepsy : a systematic review of clinical evidence for efficacy, safety, contraindications and predictors for response

Despite the introduction of many new second and third-generation antiepileptic drugs (AEDs), the number of patients with drug-resistant epilepsy (DRE) remains significant. This is particularly true for patients with focal epilepsy, the most common seizure type. When AEDs fail to control disabling seizures and patients are not optimal candidates for seizure surgery, other treatments are needed to provide additional therapeutic benefit. Neurostimulation in the treatment of epilepsy can involve either direct stimulation of brain structures or stimulation of associated structures (e.g. vagus nerve) that have connections to the brain. All neurostimulation modalities share the benefits of a lack of drug-related side-effects (e.g. cognitive, toxic, teratogenic), which contribute to favorable tolerability profiles.Vagus nerve stimulation (VNS) and closed-loop responsive neurostimulation (RNS) are the only neurostimulation modalities for epilepsy approved by the US Food and Drug Administration (FDA). Anterior thalamic stimulation (ATS) for the treatment of epilepsy is not yet approved in the United States but is available in a number of other countries. The transcranial direct current stimulation (tDCS) is a noninvasive procedure and there is moderate –to-very low-quality evidence about its effectiveness or well tolerance in DRE. The tDCS could be useful procedure for good responder selection to the deep brain stimulation (DBS). For transcutaneous vagus nerve stimulation (tVNS), transcranial magnetic stimulation (TMS) and trigeminal nerve stimulation (TNS), there are insufficient data to support the efficacy of any of these modalities for DRE. These treatment modalities, nevertheless, appear well tolerated, with no severe adverse events reported.

کلیدواژه ها:

Neurostimulation ، Drug-resistant epilepsy ، VNS ، RNS ، tDCS