Epilepsy Essentials: Neuromodulation for Drug-Resistant Epilepsy Practical Neurology 2021(6):20-23
Date
06/01/2021Abstract
Approximately one-third of individuals continue to have seizures despite the wide range of antiseizure medications (ASMs) currently available.1 Resective surgery remains an efficacious form of treatment for some who have drug-resistant epilepsy (DRE). Not all DRE, however, is suitable for surgical treatment for a variety of reasons including ictal onset zones in eloquent cortex, multiple independent ictal onset zones, or poorly localized ictal onset zone(s).2 Patient preference may also preclude resective treatment. Although these factors pose a significant treatment challenge, nonpharmacologic neurostimulation treatment options have been approved, beginning with the first implantation of a vagal nerve stimulator (VNS) in a human in 1988.3,4 Today, nonpharmacologic, nonresective options include VNS, responsive neurostimulation (RNS), and deep brain stimulation (DBS). Having options for neurostimulation means patients and physicians have important decisions to make together. In this review, we provide an overview of each of these devices to help aid the clinician in identifying the best option to recommend for an individual patient.
