Deep brain stimulation for medically refractory epilepsy.
ABSTRACT Epilepsy is a chronic neurological disorder that affects 0.5-1% of the population. Up to one-third of patients will have incompletely controlled seizures or debilitating side effects of anticonvulsant medications. Although some of these patients may be candidates for resection, many are not. The desire to find alternative treatments for epilepsy has led to a resurgence of interest in the use of deep brain stimulation (DBS), which has been used quite successfully in movement disorders. Small pilot studies and open-label trials have yielded results that may support the use of DBS in selected patients with refractory seizures. Because of the diversity of regions involved with seizure initiation and propagation, a variety of targets for stimulation have been examined. Moreover, stimulation parameters such as amplitude, frequency, pulse duration, and continuous versus intermittent on vary from one study to the next. More studies are necessary to determine if there is an appropriate population of seizure patients for DBS, the optimal target, and the most efficacious stimulation parameters.
Article: Feasibility of simultaneous vagal nerve and deep brain stimulation in chronic cluster headache: case report and considerations.[show abstract] [hide abstract]
ABSTRACT: In pathologies, such as refractory epilepsy, major depression and cluster headache, there could be indication to both vagal nerve stimulation (VNS) and deep brain stimulation (DBS). In particular, Mauskop (Cephalalgia 25:82-96, 2005) reported the efficacy and safety of VNS in chronic cluster headache. At our Institute, we perform posterior hypothalamic DBS for such clinical condition since 2000 and results appear to be encouraging. Here, we report the case of a patient with chronic cluster headache (CCH) who had initially improved after DBS, whose clinical effect subsequently diminished after head trauma; we performed VNS in the same patient, thus obtaining a new 50% reduction in frequency of pain bouts. Such benefit and the absence of any side effects (possibly due to the co-existence of the two systems) may suggest the possibility of a second therapeutical chance not only in CCH but also in the other two above-mentioned severely disabling pathological conditions.Neurological Sciences 05/2009; 30 Suppl 1:S137-9. · 1.32 Impact Factor