Neurostimulation, neuromodulation, and the treatment of epilepsies

SUMMARY Introduction.Neurostimulation and neuromodulation are techniques that may be able to affect the course of epilepsy. In the last 20 years, since the approval of VNS, we have observed a surge of studies assessing the potential of other devices and techniques for the treatment of pharmacoresistant epilepsies including deep brain stimulation (DBS), responsive neurostimulation (RNS), trigeminal nerve stimulation (TNS), transcranial direct current stimulation (tDCS), and repetitive transcranial magnetic stimulation (rTMS). Are these devices and techniques simply another treatment option that can be offered to patients with epilepsy or do they offer specific advantages when compared to the standard antiepileptic drugs (AEDs)? Aim.The aim of this review is to present the neurostimulation and neuromodulation devices and techniques that are now in use, or at least available for testing and to discuss the science behind them, their applications, efficacy, potential risks vs. benefits and, above all, how to navigate the choices so clinicians are able to provide their patients with the best possible option for the treatment of epilepsy. Material and methods.We analyzed PubMed and MEDLINE databases to select the most salient and recent (up to November 2014) publications on each treatment device. In addition to these searches bibliographies of selected articles were hand-searched for possible sources. Discussion and conclusions.Great progress in neurostimulation and neuromodulation has been made over the last two decades with 2 devices (VNS, RNS) approved for the treatment of epilepsy in the US and three (DBS in addition to VNS and RNS) in Europe. The future of neuromodulation/neurostimulation is exciting – various studies and efforts are underway and will provide us with more data in the future. There appears to be one clear advantage of these treatments/devices over the AEDs that is consistently noted – routinely observed is continuous improvement in seizure control over time. This is something that the AEDs have thus far failed to deliver.