Chronic subthreshold cortical stimulation: a therapeutic and potentially restorative therapy for focal epilepsy

Expert Review of Neurotherapeutics
Brian Nils LundstromJamie Van Gompel

Abstract

Approximately one third of patients with focal epilepsy continue to have ongoing seizures despite adequate trials of anti-seizure medications. Surgery to remove the epileptogenic zone remains the most efficacious treatment option for focal drug-resistant epilepsy. However, when cortical areas are eloquent or there are multiple epileptogenic zones, surgical resection is not an ideal approach. Cortical stimulation provides an attractive alternative. Area covered: Here, the authors describe Chronic Subthreshold Cortical Stimulation (CSCS), which uses continuous intracranial electrical stimulation applied near the epileptogenic zone to lower seizure probability. The authors review literature related to CSCS. One challenge is finding the most efficacious set of stimulation parameters for each patient. Expert commentary: Data supporting CSCS are limited but promising for the treatment of patients with focal drug resistant epilepsy who are not surgical candidates. Additional electrophysiological biomarkers to estimate cortical excitability are needed.

References

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Citations

Dec 22, 2017·Brain Sciences·Timothy Marc Eastin, Miguel Angel Lopez-Gonzalez
Dec 19, 2018·Journal of Neural Engineering·Steven BaldassanoBrian Litt
Jul 3, 2018·Therapeutic Advances in Chronic Disease·Alendia Hartshorn, Barbara Jobst
Oct 23, 2019·Brain Sciences·Keith StarnesBrian Nils Lundstrom
Jul 11, 2020·Current Neurology and Neuroscience Reports·Sara Dawit, Amy Z Crepeau
Mar 20, 2018·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·Brian Nils LundstromGreg Worrell
Mar 11, 2021·Journal of Neural Engineering·Praveen VenkateshVasileios Kokkinos
Jul 10, 2021·Frontiers in Neurology·Antonella FattorussoAlberto Verrotti

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