Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures

Joanna H Cox1 Stefano Seri2,3 Andrea E Cavanna1,2,4,51College of Medical and Dental Sciences, University of Birmingham, 2School of Life and Health Sciences, Aston Brain Centre, Aston University, 3Children’s Epilepsy Surgery Programme, The Birmingham Children’s Hospital...

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Autores principales:	Cox JH, Seri S, Cavanna AE
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/cc4863352836406f9e7c40c3127f6a77
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spelling	oai:doaj.org-article:cc4863352836406f9e7c40c3127f6a772021-12-02T06:52:11ZClinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures1178-2021https://doaj.org/article/cc4863352836406f9e7c40c3127f6a772014-11-01T00:00:00Zhttp://www.dovepress.com/clinical-utility-of-implantable-neurostimulation-devices-as-adjunctive-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021 Joanna H Cox1 Stefano Seri2,3 Andrea E Cavanna1,2,4,51College of Medical and Dental Sciences, University of Birmingham, 2School of Life and Health Sciences, Aston Brain Centre, Aston University, 3Children’s Epilepsy Surgery Programme, The Birmingham Children’s Hospital NHS Foundation Trust, 4Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; 5Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and UCL, London, UK Abstract: About one third of patients with epilepsy are refractory to medical treatment. For these patients, alternative treatment options include implantable neurostimulation devices such as vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation systems (RNS). We conducted a systematic literature review to assess the available evidence on the clinical efficacy of these devices in patients with refractory epilepsy across their lifespan. VNS has the largest evidence base, and numerous randomized controlled trials and open-label studies support its use in the treatment of refractory epilepsy. It was approved by the US Food and Drug Administration in 1997 for treatment of partial seizures, but has also shown significant benefit in the treatment of generalized seizures. Results in adult populations have been more encouraging than in pediatric populations, where more studies are required. VNS is considered a safe and well-tolerated treatment, and serious side effects are rare. DBS is a well-established treatment for several movement disorders, and has a small evidence base for treatment of refractory epilepsy. Stimulation of the anterior nucleus of the thalamus has shown the most encouraging results, where significant decreases in seizure frequency were reported. Other potential targets include the centromedian thalamic nucleus, hippocampus, cerebellum, and basal ganglia structures. Preliminary results on RNS, new-generation implantable neurostimulation devices which stimulate brain structures only when epileptic activity is detected, are encouraging. Overall, implantable neurostimulation devices appear to be a safe and beneficial treatment option for patients in whom medical treatment has failed to adequately control their epilepsy. Further large-scale randomized controlled trials are required to provide a sufficient evidence base for the inclusion of DBS and RNS in clinical guidelines. Keywords: deep brain stimulation, epilepsy, implantable neurostimulation device, responsive neurostimulation, seizures, vagus nerve stimulation Cox JHSeri SCavanna AEDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2014, Iss default, Pp 2191-2200 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Cox JH Seri S Cavanna AE Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures
description	Joanna H Cox1 Stefano Seri2,3 Andrea E Cavanna1,2,4,51College of Medical and Dental Sciences, University of Birmingham, 2School of Life and Health Sciences, Aston Brain Centre, Aston University, 3Children’s Epilepsy Surgery Programme, The Birmingham Children’s Hospital NHS Foundation Trust, 4Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK; 5Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and UCL, London, UK Abstract: About one third of patients with epilepsy are refractory to medical treatment. For these patients, alternative treatment options include implantable neurostimulation devices such as vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation systems (RNS). We conducted a systematic literature review to assess the available evidence on the clinical efficacy of these devices in patients with refractory epilepsy across their lifespan. VNS has the largest evidence base, and numerous randomized controlled trials and open-label studies support its use in the treatment of refractory epilepsy. It was approved by the US Food and Drug Administration in 1997 for treatment of partial seizures, but has also shown significant benefit in the treatment of generalized seizures. Results in adult populations have been more encouraging than in pediatric populations, where more studies are required. VNS is considered a safe and well-tolerated treatment, and serious side effects are rare. DBS is a well-established treatment for several movement disorders, and has a small evidence base for treatment of refractory epilepsy. Stimulation of the anterior nucleus of the thalamus has shown the most encouraging results, where significant decreases in seizure frequency were reported. Other potential targets include the centromedian thalamic nucleus, hippocampus, cerebellum, and basal ganglia structures. Preliminary results on RNS, new-generation implantable neurostimulation devices which stimulate brain structures only when epileptic activity is detected, are encouraging. Overall, implantable neurostimulation devices appear to be a safe and beneficial treatment option for patients in whom medical treatment has failed to adequately control their epilepsy. Further large-scale randomized controlled trials are required to provide a sufficient evidence base for the inclusion of DBS and RNS in clinical guidelines. Keywords: deep brain stimulation, epilepsy, implantable neurostimulation device, responsive neurostimulation, seizures, vagus nerve stimulation
format	article
author	Cox JH Seri S Cavanna AE
author_facet	Cox JH Seri S Cavanna AE
author_sort	Cox JH
title	Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures
title_short	Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures
title_full	Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures
title_fullStr	Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures
title_full_unstemmed	Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures
title_sort	clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/cc4863352836406f9e7c40c3127f6a77
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Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures

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