Neuromodulation for Epilepsy

Anti-seizure medications are the first-line treatments for those with a tendency toward recurrent seizures, or epilepsy and chronically alter the excitability of many or most cerebral neurons. There are three brain stimulation approaches that are US Food and Drug Administration-approved for the treatment of epilepsy: vagus nerve stimulation (VNS), responsive neurostimulation, and thalamic deep-brain stimulation. This chapter focuses on these invasive approaches. Overall response to VNS was predicted by non-lesional epilepsy. Long-term safety data suggest a 3% risk of permanent vagus nerve damage and 5% risk of lead fracture. VNS reduces the risk of sudden unexpected death in epilepsy from approximately 6–7 per 1000 patient years for patients to approximately 2 per 1000 patient years, an effect that seems to strengthen over time. In many regards, neuromodulation for epilepsy remains in its infancy, with underlying pathophysiology poorly understood despite clear evidence of efficacy via multiple stimulation approaches.