Nov. 3, 2021

Neuromodulation in epilepsy: state-of-the-art approved therapies


The Lancet Neurology recently published a paper with Professor P. Ryvlin, one of the Human Brain Project scientific experts, as lead author.

The paper is the result of the work carried out by a group of international scientists and reviews the current status of neuro-modulation therapies in epilepsy.  The authors argue that future studies are needed to address the shortfalls in knowledge about these therapies (long-term outcomes, adverse events, predictive use, …), to approve novel forms of neuro-modulation, and to develop personalised closed-loop therapies with embedded machine learning.

Summary

Three neuromodulation therapies have been appropriately tested and approved in refractory focal epilepsies: vagus nerve stimulation (VNS), deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS), and closed-loop responsive neurostimulation of the epileptogenic zone or zones. These therapies are primarily palliative. Only a few individuals have achieved complete freedom from seizures for more than 12 months with these therapies, whereas more than half have benefited from long-term reduction in seizure frequency of more than 50%. Implantation-related adverse events primarily include infection and pain at the implant site. Intracranial haemorrhage is a frequent adverse event for ANT-DBS and responsive neurostimulation. Other stimulation-specific side-effects are observed with VNS and ANT-DBS. Biomarkers to predict response to neuromodulation therapies are not available, and high-level evidence to aid decision making about when and for whom these therapies should be preferred over other antiepileptic treatments is scant. Future studies are thus needed to address these shortfalls in knowledge, approve other forms of neuromodulation, and develop personalised closed-loop therapies with embedded machine learning. Until then, neuromodulation could be considered for individuals with intractable seizures, ideally after the possibility of curative surgical treatment has been carefully assessed and ruled out or judged less appropriate.

Further reading

https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(21)00300-8/fulltext