REVIEWS  BRAIN NEUROMODULATION SURGERY 

Journal of Neurosurgical Sciences 2016 June;60(2):189-98

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Deep brain stimulation for intractabile epilepsy

Roberta MORACE ¹, Giancarlo DI GENNARO ¹, Pierpaolo QUARATO ¹, Alfredo D’ANIELLO ¹, Addolorata MASCIA ¹, Liliana GRAMMALDO ¹, Marco DE RISI ¹, Antonio SPARANO ¹, Michelangelo DE ANGELIS ^{1, 2}, Francesco DI COLA ¹, Domenico SOLARI ², Vincenzo ESPOSITO ^{1, 3} ✉

¹ I.R.C.C.S. Neuromed, Pozzilli, Isernia, Italy; ² Department of Neuroscience and Reproductive and Odontostomatological Science, “Federico II” University of Naples, Naples, Italy; ³ Department of Neurology and Psychiatry, “Sapienza” University of Rome, Rome, Italy

INTRODUCTION: Deep brain stimulation (DBS) is currently considered a promising neuromodulation therapy for refractory epilepsy not suitable for resective surgery. Several anatomical targets and different stimulation approaches have been proposed in order to obtain satisfactory seizures reduction. As expected, according with different patterns of neural pathways involvement, the efficacy of each anatomical target stimulation in reducing seizure frequency varies among the different epileptic syndromes.
EVIDENCE ACQUISITION: We reviewed the current literature on this topic to provide an overview of the clinical efficacy of the main stimulation targets (anterior nucleus of the thalamus [ANT], hippocampus formation [HF] and centromedian nucleus of the thalamus [CMT]) related to the different epileptic syndromes. We also summarized the available data concerning side effects, neuropsychological outcome, quality of life and future perspective of DBS in intractable epilepsy.
EVIDENCE SYNTHESIS: Encouraging results were reported for each target stimulation. However, only in ANT and responsive neurostimulation (RNS) the efficacy and safety were tested on large series of patients and achieving class I evidence level.
CONSLUSIONS: We concluded that responsive stimulation could be more appropriate in focal epilepsy, while ANT stimulation could be properly performed also in multifocal seizures with predominant limbic involvement. Despite the small samples size, HF stimulation reduces seizure frequency in (bi) temporal lobe epilepsy, as well as CMT stimulation is able to reduce, seizure frequency, in generalized epilepsy.