Therapeutic devices provide new options for treating drug-resistant epilepsy. These devices act by
a variety of mechanisms to modulate neuronal activity. Only vagus nerve stimulation, which
continues to develop new technology, is approved for use in the United States. Deep brain
stimulation (DBS) of anterior thalamus for partial epilepsy recently was approved in Europe and
several other countries. Responsive neurostimulation, which delivers stimuli to one or two seizure
foci in response to a detected seizure, recently completed a successful multicenter trial. Several
other trials of brain stimulation are in planning or underway. Transcutaneous magnetic stimulation
(TMS) may provide a noninvasive method to stimulate cortex. Controlled studies of TMS split on
efficacy, and may depend on whether a seizure focus is near a possible region for stimulation.
Seizure detection devices in the form of “shake” detectors via portable accelerometers can provide
notification of an ongoing tonic-clonic seizure, or peace of mind in the absence of notification.
Prediction of seizures from various aspects of EEG is in early stages. Prediction appears to be
possible in a subpopulation of people with refractory seizures and a clinical trial of an implantable
prediction device is underway. Cooling of neocortex or hippocampus reversibly can attenuate
epileptiform EEG activity and seizures, but engineering problems remain in its implementation.
Optogenetics is a new technique that can control excitability of specific populations of neurons
with light. Inhibition of epileptiform activity has been demonstrated in hippocampal slices, but use
in humans will require more work. In general, devices provide useful palliation for otherwise
uncontrollable seizures, but with a different risk profile than with most drugs. Optimizing the
place of devices in therapy for epilepsy will require further development and clinical experience
Therapeutic devices provide new options for treating drug-resistant epilepsy. These devices act bya variety of mechanisms to modulate neuronal activity. Only vagus nerve stimulation, whichcontinues to develop new technology, is approved for use in the United States. Deep brainstimulation (DBS) of anterior thalamus for partial epilepsy recently was approved in Europe andseveral other countries. Responsive neurostimulation, which delivers stimuli to one or two seizurefoci in response to a detected seizure, recently completed a successful multicenter trial. Severalother trials of brain stimulation are in planning or underway. Transcutaneous magnetic stimulation(TMS) may provide a noninvasive method to stimulate cortex. Controlled studies of TMS split onefficacy, and may depend on whether a seizure focus is near a possible region for stimulation.Seizure detection devices in the form of “shake” detectors via portable accelerometers can providenotification of an ongoing tonic-clonic seizure, or peace of mind in the absence of notification.Prediction of seizures from various aspects of EEG is in early stages. Prediction appears to bepossible in a subpopulation of people with refractory seizures and a clinical trial of an implantableprediction device is underway. Cooling of neocortex or hippocampus reversibly can attenuateepileptiform EEG activity and seizures, but engineering problems remain in its implementation.Optogenetics is a new technique that can control excitability of specific populations of neuronswith light. Inhibition of epileptiform activity has been demonstrated in hippocampal slices, but usein humans will require more work. In general, devices provide useful palliation for otherwiseuncontrollable seizures, but with a different risk profile than with most drugs. Optimizing theplace of devices in therapy for epilepsy will require further development and clinical experience
การแปล กรุณารอสักครู่..
