Disrupting abnormal electrical activity with deep brain stimulation: is epilepsy the next frontier?

2010 ◽  
Vol 29 (2) ◽  
pp. E7 ◽  
Author(s):  
Maryam Rahman ◽  
Muhammad M. Abd-El-Barr ◽  
Vinata Vedam-Mai ◽  
Kelly D. Foote ◽  
Gregory J. A. Murad ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Best Practices ◽  
Brain Stimulation ◽  
Intractable Epilepsy ◽  
Interdisciplinary Teams ◽  
Thalamic Nuclei ◽  
Therapeutic Approaches ◽  
Stimulation Parameters ◽  
Refractory Seizures ◽  
Deep Brain

Given the tremendous success of deep brain stimulation (DBS) for the treatment of movement and neuropsychiatric disorders, clinicians have begun to open up to the possible use of electrical stimulation for the treatment of patients with uncontrolled seizures. This process has resulted in the discovery of a wide array of DBS targets, including the cerebellum, hypothalamus, hippocampus, basal ganglia, and various thalamic nuclei. Despite the ambiguity of the mechanism of action and the unknowns surrounding potentially ideal stimulation settings, several recent trials have empirically demonstrated reasonable efficacy in selected cases of medication-refractory seizures. These exciting results have fueled a number of studies aimed at firmly establishing DBS as an effective treatment for selected cases of intractable epilepsy, and many companies are aiming at Food and Drug Administration approval. We endeavor to review the studies in the context of the various DBS targets and their relevant circuitry for epilepsy. Based on the unfolding research, DBS has the potential to play an important role in treating refractory epilepsy. The challenge, as in movement disorders, is to assemble interdisciplinary teams to screen, implant, and follow patients, and to clarify patient selection. The future will undoubtedly be filled with optimization of targets and stimulation parameters and the development of best practices. With tailored therapeutic approaches, epilepsy patients have the potential to improve with DBS.

scholarly journals Deep brain stimulation for seizure control in drug-resistant epilepsy

2018 ◽  
Vol 45 (2) ◽  
pp. E4 ◽  
Author(s):  
Neil Klinger ◽  
Sandeep Mittal
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Seizure Control ◽  
Effective Means ◽  
Drug Resistant ◽  
Thalamic Nuclei ◽  
Stimulation Parameters ◽  
Number Of Patients ◽  
Drug Resistant Epilepsy ◽  
Deep Brain

Antiepileptic drugs prevent morbidity and death in a large number of patients suffering from epilepsy. However, it is estimated that approximately 30% of epileptic patients will not have adequate seizure control with medication alone. Resection of epileptogenic cortex may be indicated in medically refractory cases with a discrete seizure focus in noneloquent cortex. For patients in whom resection is not an option, deep brain stimulation (DBS) may be an effective means of seizure control. Deep brain stimulation targets for treating seizures primarily include the thalamic nuclei, hippocampus, subthalamic nucleus, and cerebellum. A variety of stimulation parameters have been studied, and more recent advances in electrical stimulation to treat epilepsy include responsive neurostimulation. Data suggest that DBS is effective for treating drug-resistant epilepsy.

scholarly journals Deep Brain Stimulation of Thalamic Nuclei for Treatment of Intractable Epilepsy

2015 ◽  
Vol 2 (3) ◽  
Author(s):  
Nasrin Mehranfard ◽  
Seyed Shahabeddin Sadr ◽  
Gholam Hossein Meftahi ◽  
Zahra Bahari ◽  
Maedeh Ghasemi ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Intractable Epilepsy ◽  
Thalamic Nuclei ◽  
Deep Brain ◽  
Stimulation Of

Deep brain stimulation for medically refractory epilepsy

2008 ◽  
Vol 25 (3) ◽  
pp. E11 ◽  
Author(s):  
Thomas L. Ellis ◽  
Andrew Stevens
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Open Label ◽  
Pilot Studies ◽  
Stimulation Parameters ◽  
Initiation And Propagation ◽  
Optimal Target ◽  
Refractory Seizures ◽  
Frequency Pulse ◽  
Deep Brain

Epilepsy is a chronic neurological disorder that affects 0.5–1% of the population. Up to one-third of patients will have incompletely controlled seizures or debilitating side effects of anticonvulsant medications. Although some of these patients may be candidates for resection, many are not. The desire to find alternative treatments for epilepsy has led to a resurgence of interest in the use of deep brain stimulation (DBS), which has been used quite successfully in movement disorders. Small pilot studies and open-label trials have yielded results that may support the use of DBS in selected patients with refractory seizures. Because of the diversity of regions involved with seizure initiation and propagation, a variety of targets for stimulation have been examined. Moreover, stimulation parameters such as amplitude, frequency, pulse duration, and continuous versus intermittent on vary from one study to the next. More studies are necessary to determine if there is an appropriate population of seizure patients for DBS, the optimal target, and the most efficacious stimulation parameters.

scholarly journals High-fidelity transmission of high-frequency burst stimuli from peripheral nerve to thalamic nuclei in children with dystonia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Estefanía Hernandez-Martin ◽  
Enrique Arguelles ◽  
Yifei Zheng ◽  
Ruta Deshpande ◽  
Terence D. Sanger
Keyword(s):  
Deep Brain Stimulation ◽  
Peripheral Nerve ◽  
Brain Stimulation ◽  
High Frequency ◽  
Sensory Information ◽  
Brain Structures ◽  
High Fidelity ◽  
Thalamic Nuclei ◽  
Frequency Burst ◽  
Deep Brain

AbstractHigh-frequency peripheral nerve stimulation has emerged as a noninvasive alternative to thalamic deep brain stimulation for some patients with essential tremor. It is not known whether such techniques might be effective for movement disorders in children, nor is the mechanism and transmission of the peripheral stimuli to central brain structures understood. This study was designed to investigate the fidelity of transmission from peripheral nerves to thalamic nuclei in children with dystonia undergoing deep brain stimulation surgery. The ventralis intermediate (VIM) thalamus nuclei showed a robust evoked response to peripheral high-frequency burst stimulation, with a greatest response magnitude to intra-burst frequencies between 50 and 100 Hz, and reliable but smaller responses up to 170 Hz. The earliest response occurred at 12–15 ms following stimulation onset, suggesting rapid high-fidelity transmission between peripheral nerve and thalamic nuclei. A high-bandwidth, low-latency transmission path from peripheral nerve to VIM thalamus is consistent with the importance of rapid and accurate sensory information for the control of coordination and movement via the cerebello-thalamo-cortical pathway. Our results suggest the possibility of non-invasive modulation of thalamic activity in children with dystonia, and therefore the possibility that a subset of children could have beneficial clinical response without the need for invasive deep brain stimulation.

scholarly journals iHandU: A Novel Quantitative Wrist Rigidity Evaluation Device for Deep Brain Stimulation Surgery

Sensors ◽  
2020 ◽  
Vol 20 (2) ◽  
pp. 331 ◽  
Author(s):  
Elodie Múrias Lopes ◽  
Maria do Carmo Vilas-Boas ◽  
Duarte Dias ◽  
Maria José Rosas ◽  
Rui Vaz ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Lessons Learned ◽  
Wrist Flexion ◽  
Stimulation Parameters ◽  
Average Accuracy ◽  
Gyroscope Sensor ◽  
Work Done ◽  
Deep Brain Stimulation Surgery ◽  
Deep Brain

Deep brain stimulation (DBS) surgery is the gold standard therapeutic intervention in Parkinson’s disease (PD) with motor complications, notwithstanding drug therapy. In the intraoperative evaluation of DBS’s efficacy, neurologists impose a passive wrist flexion movement and qualitatively describe the perceived decrease in rigidity under different stimulation parameters and electrode positions. To tackle this subjectivity, we designed a wearable device to quantitatively evaluate the wrist rigidity changes during the neurosurgery procedure, supporting physicians in decision-making when setting the stimulation parameters and reducing surgery time. This system comprises a gyroscope sensor embedded in a textile band for patient’s hand, communicating to a smartphone via Bluetooth and has been evaluated on three datasets, showing an average accuracy of 80%. In this work, we present a system that has seen four iterations since 2015, improving on accuracy, usability and reliability. We aim to review the work done so far, outlining the iHandU system evolution, as well as the main challenges, lessons learned, and future steps to improve it. We also introduce the last version (iHandU 4.0), currently used in DBS surgeries at São João Hospital in Portugal.

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