A Comprehensive Review of Emerging Trends and Innovative Therapies in Epilepsy Management

Brain Sciences, Journal Year: 2023, Volume and Issue: 13(9), P. 1305 - 1305

Published: Sept. 11, 2023

Epilepsy is a complex neurological disorder affecting millions worldwide, with substantial number of patients facing drug-resistant epilepsy. This comprehensive review explores innovative therapies for epilepsy management, focusing on their principles, clinical evidence, and potential applications. Traditional antiseizure medications (ASMs) form the cornerstone treatment, but limitations necessitate alternative approaches. The delves into cutting-edge such as responsive neurostimulation (RNS), vagus nerve stimulation (VNS), deep brain (DBS), highlighting mechanisms action promising outcomes. Additionally, gene optogenetics in research discussed, revealing groundbreaking findings that shed light seizure mechanisms. Insights cannabidiol (CBD) ketogenic diet adjunctive further broaden spectrum management. Challenges achieving control traditional therapies, including treatment resistance individual variability, are addressed. importance staying updated emerging trends management emphasized, along hope improved therapeutic options. Future directions, combining AI applications, non-invasive optogenetics, hold promise personalized effective treatment. As field advances, collaboration among researchers natural synthetic biochemistry, clinicians from different streams various forms medicine, will drive progress toward better higher quality life individuals living

Language: Английский

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Unearthing the mechanisms of responsive neurostimulation for epilepsy

Communications Medicine, Journal Year: 2023, Volume and Issue: 3(1)

Published: Nov. 16, 2023

Responsive neurostimulation (RNS) is an effective therapy for people with drug-resistant focal epilepsy. In clinical trials, RNS results in a meaningful reduction median seizure frequency, but the response highly variable across individuals, many receiving minimal or no benefit. Understanding why this variability occurs will help improve use of therapy. Here we advocate reexamination assumptions made about how reduces seizures. This now possible due to large patient cohorts having used device, some long-term. Two foundational have been that device's intracranial leads should target focus/foci directly, and stimulation be triggered only detected epileptiform activity. Recent studies called into question both hypotheses. Here, discuss these exciting new suggest future approaches selection, lead placement, device programming could outcomes.

Language: Английский

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Current state of the epilepsy drug and device pipeline

Epilepsia, Journal Year: 2024, Volume and Issue: 65(4), P. 833 - 845

Published: Feb. 12, 2024

Abstract The field of epilepsy has undergone substantial advances as we develop novel drugs and devices. Yet considerable challenges remain in developing broadly effective, well‐tolerated treatments, but also precision treatments for rare epilepsies seizure‐monitoring We summarize major recent ongoing innovations diagnostic therapeutic products presented at the seventeenth Epilepsy Therapies & Diagnostics Development (ETDD) conference, which occurred May 31 to June 2, 2023, Aventura, Florida. Therapeutics under development are targeting genetics, ion channels other neurotransmitters, many potentially first‐in‐class interventions such stem cells, glycogen metabolism, cholesterol, gut microbiome, modalities delivering electrical neuromodulation.

Language: Английский

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On brain stimulation in epilepsy

Brain, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 2, 2025

Abstract Brain stimulation has, for many decades, been considered as a potential solution the unmet needs of people living with drug-resistant epilepsy. Clinically, there are several different approaches in use, including vagus nerve (VNS), deep brain thalamus, and responsive neurostimulation (RNS). Across populations patients, all deliver reductions seizure load SUDEP risk, yet do so variably, improvements seem incremental rather than transformative. In contrast, within field experimental neuroscience, transformational impact optogenetic is evident; by providing means to control subsets neurons isolation, it has revolutionized our ability dissect out functional relations neuronal microcircuits. It worth asking, therefore, how pre-clinical optogenetics research could advance clinical practice epilepsy? Here, we review state field, recent progress animal research. We report various breakthrough results, development new models initiation, its use prediction, fast, closed-loop pathological rhythms, what these experiments tell us about epileptic pathophysiology. Finally, consider advances may be translated into practice.

Language: Английский

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Advancing Thalamic neuromodulation in Epilepsy: Bridging Adult Data to Pediatric Care

Epilepsy Research, Journal Year: 2024, Volume and Issue: 205, P. 107407 - 107407

Published: July 6, 2024

Language: Английский

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Corticothalamic Responsive Neurostimulation for Focal Epilepsy: A Single-Center Experience

Journal of Clinical Neurophysiology, Journal Year: 2024, Volume and Issue: 41(7), P. 630 - 639

Published: Jan. 9, 2024

Purpose: Owing to its extensive, reciprocal connectivity with the cortex and other subcortical structures, thalamus is considered an important target for neuromodulation in drug-resistant focal epilepsy. Using corticothalamic stimulation, it possible modulate both cortical seizure onset zone. Limited published clinical experience describes stimulation depth leads targeting one of anterior (ANT), centromedian (centromedian nucleus), or pulvinar (PUL) thalamic nuclei. However, not clear which these nuclei “best” therapeutic target. Methods: This study comprised a single-center responsive neurostimulation using RNS System three Presented here are methods selection device programming as well outcomes comparison ictal nonictal electrophysiological features. Results: In this small retrospective ( N = 19), was effective therapy 79% patients (≥50% reduction disabling frequency), regardless whether lead implanted ANT 2), PUL 6), nucleus 11). Twenty-six percent reported frequency ≥90%. Both high (≥100 Hz) low (≤20 were used stimulate depending on patient's response ability tolerate higher charge densities. all patients, longer burst duration (2000–5000 ms) ultimately implemented leads. Across peaks intracranial EEG observed at theta, beta, gamma, sleep spindle frequencies. Changes content distribution over time Conclusions: These results indicate that can potentially be adjunctive data also contribute broader understanding electrophysiology context

Language: Английский

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Emerging approaches in neurostimulation for epilepsy

Current Opinion in Neurology, Journal Year: 2023, Volume and Issue: unknown

Published: Feb. 8, 2023

Purpose of review Neurostimulation is a quickly growing treatment approach for epilepsy patients. We summarize recent approaches to provide perspective on the future neurostimulation. Recent findings Invasive stimulation focal includes vagus nerve stimulation, responsive neurostimulation cortex and deep brain anterior nucleus thalamus. A wide range other targets have been considered, including centromedian, central lateral pulvinar thalamic nuclei; medial septum, accumbens, subthalamic nucleus, cerebellum, fornicodorsocommissure piriform cortex. Stimulation generalized onset seizures mixed epilepsies as well increased efforts focusing paediatric populations emerged. Hardware with more permanently implanted lead options sensing capabilities emerging. wider variety programming than typically used may improve patient outcomes. Finally, noninvasive its favourable risk profile offers potential treat increasingly diverse Summary surprisingly varied. Flexibility reversibility allows rapid innovation. There remains continued need excitability biomarkers guide Neurostimulation, part bioelectronic medicine, distinctive benefits unique challenges.

Language: Английский

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Stimulation to probe, excite, and inhibit the epileptic brain

Epilepsia, Journal Year: 2023, Volume and Issue: 64(S3)

Published: May 17, 2023

Direct cortical stimulation has been applied in epilepsy for nearly one century and experienced a renaissance given unprecedented opportunities to probe, excite inhibit the human brain. Evidence suggests can increase diagnostic therapeutic utility patients with drug-resistant epilepsies. However, choosing appropriate parameters is not trivial issue, which further complicated by fact that characterized complex brain state dynamics. In this article derived from discussions at ICTALS 2022 conference, we succinctly review literature on acutely chronically epileptic localization, monitoring, purposes. particular, discuss how used probe excitability, evidence usefulness of trigger stop seizures, applications stimulation, finally are impacted Although research advanced considerably over past decade, there still significant hurdles optimize use technique. For example, it remains unclear what extent short timescale biomarkers predict long-term outcomes these add information already existing passive EEG recordings. Further questions include closed loop offers advantages open optimal timescales may be, whether biomarker-informed lead seizure freedom. The ultimate goal bioelectronic medicine just seizures but rather cure its comorbidities.

Language: Английский

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Bilateral centromedian nucleus of thalamus responsive neurostimulation for pediatric‐onset drug‐resistant epilepsy

Epilepsia, Journal Year: 2024, Volume and Issue: 65(8)

Published: June 7, 2024

Abstract Neuromodulation therapies offer an efficacious treatment alternative for patients with drug‐resistant epilepsy (DRE), particularly those unlikely to benefit from surgical resection. Here we present our retrospective single‐center case series of pediatric‐onset DRE who underwent responsive neurostimulation (RNS) depth electrode implantation targeting the bilateral centromedian nucleus (CM) thalamus between October 2020 and 2022. Sixteen were identified; seizure outcomes, programming parameters, complications at follow‐up reviewed. The median age was 13 years (range 3.6–22). Six (38%) younger than 12 time implantation. Ictal electroencephalography (EEG) patterns during patients’ most disabling seizures reliably detected. Ten (62%) achieved 50% or greater reduction in frequency a 1.3 0.6–2.6) follow‐up. Eight (50%) experienced sensorimotor side effects, three (19%) had superficial pocket infection, prompting removal RNS device. Side effects stimulation mostly monopolar‐cathodal configuration alleviated change bipolar low‐frequency stimulation. Closed‐loop using CM is feasible useful therapy DRE.

Language: Английский

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Centromedian thalamic deep brain stimulation for idiopathic generalized epilepsy: Connectivity and target optimization

Epilepsia, Journal Year: 2024, Volume and Issue: 65(11)

Published: Sept. 14, 2024

Abstract There are limited treatment options for individuals with drug‐resistant idiopathic generalized epilepsy (IGE). Small, case series suggest that centromedian thalamus deep brain stimulation (CM‐DBS) may be an effective option. The optimal CM‐DBS target IGE is underexamined. Here, we present a retrospective analysis of targeting and efficacy five patients IGE. Volume tissue activated (VTA) overlap CM nucleus was performed using open‐source toolbox. Median follow‐up time 13 months. convulsive seizure frequency reduction 66%. One patient had only absence seizures, >99% in frequency. Four electrode contacts positioned within the target, all whom >50% primary semiology seizure, 85% median ( p = .004, paired‐sample t test). Volumetric “sweet‐spot” mapping revealed best outcomes were correlated middle ventral nucleus. Connectivity strength between sweet‐spot region central peri‐Rolandic cortex increased significantly relative to other cortical regions 8.6 × 10 −4 , Mann–Whitney U Our findings indicate can IGE, highlight importance accurate analysis, context prior work, ideal targets syndrome specific.

Language: Английский

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