Neurológia pre prax 5/2013

Deep brain stimulation in the context of neurostimulation treatment of epilepsy

An epileptic seizure is a manifestation of synchronization and spread of abnormally organized rhythmic elec¬trical activity of the brain. Neurostimulation techniques modulate large-scale distributed neuronal networks, including those involved in epileptic processes. Vagus nerve stimulation and deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) are routinely utilized in clinical practice. Both are effective palliative methods in the treatment of pharmacoresistant epilepsy. Further stimulation targets are being tested; as yet, smaller cohorts of patients with DBS of the subthalamic nucleus, caudate nucleus, centrum medianum of the thalamus and posterior hypothalamus have been published. Novel methods of stimulation are also being tested, with the most advanced being the stimulation of epileptic cortex in a closed loop (responsive brain stimulation). Further target structures, optimal methods and their technical parameters as well as appropriate in¬dications are being searched for and tested.

Keywords: epilepsy, neurostimulation, deep brain stimulation, nucleus anterior thalami.