Deep brain stimulation involves electrical stimulation of specific subcortical nuclei, which have widespread neural connections. In a randomized controlled trial of 109 patients with refractory epilepsy who had DBS electrodes implanted in the anterior nucleus of the thalamus there was 29% greater reduction in seizures for 54 patients, who had the stimulator switched as compared to 55 patients who had their stimulation turned off after a blinded period of 3 months.47,49
Unlike other methods of neurostimulation, responsive neurostimulation (RNS) does not deliver electrical stimulation at specific frequencies throughout the day, instead the RNS device is composed of a combined recorder and stimulator device which detects clinically relevant epileptiform discharges and delivers appropriate electrical stimuli in response. This non-invasive neurostimulation technique with low frequency repetitive transcranial magnetic stimulation (rTMS) might suppress cortical excitability either via inducing long term depression or by enhancing GABAergic inhibition, but the evidence for its efficacy is still limited.47