Responsive neurostimulation for the treatment of medically intractable epilepsy

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• 作者：Chong Liu ; Xiong-Wei Wen ; Yan Ge ; Ning Chen ; Wen-Han Hu ; Tan Zhang ; Jian-Guo Zhang ; Fan-Gang Meng
• 关键词：AD ; afterdischarge ; ANT ; anterior nuclei of the thalamus ; CMT ; centromedian nucleus of the thalamus ; CN ; caudate nucleus ; DBS ; deep brain stimulation ; ECoG ; electrocorticogram ; EEG ; electroencephalogram ; HFES ; high-frequency electrical stimulation ; MRF ; m
• 刊名：Brain Research Bulletin
• 出版年：2013
• 出版时间：August, 2013
• 年：2013
• 卷：97
• 期：Complete
• 页码：39-47
• 全文大小：1222 K

文摘

With an annual incidence of 50/100,000 people, nearly 1 % of the population suffers from epilepsy. Treatment with antiepileptic medication fails to achieve seizure remission in 20-30 % of patients. One treatment option for refractory epilepsy patients who would not otherwise be surgical candidates is electrical stimulation of the brain, which is a rapidly evolving and reversible adjunctive therapy. Therapeutic stimulation can involve direct stimulation of the brain nuclei or indirect stimulation of peripheral nerves. There are three stimulation modalities that have class I evidence supporting their uses: vagus nerve stimulation (VNS), stimulation of the anterior nuclei of the thalamus (ANT), and, the most recently developed, responsive neurostimulation (RNS). While the other treatment modalities outlined deliver stimulation regardless of neuronal activity, the RNS administers stimulation only if triggered by seizure activity. The lower doses of stimulation provided by such responsive devices can not only reduce power consumption, but also prevent adverse reactions caused by continuous stimulation, which include the possibility of habituation to long-term stimulation. RNS, as an investigational treatment for medically refractory epilepsy, is currently under review by the FDA. Eventually systems may be developed to enable activation by neurochemical triggers or to wirelessly transmit any information gathered. We review the mechanisms, the current status, the target options, and the prospects of RNS for the treatment of medically intractable epilepsy.