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The Role of Neuromodulation in the Treatment of Refractory Epilepsy

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Pharmacoresistance in Epilepsy

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Abstract

Neuromodulation or electrical stimulation of the neural tissue instead of performing lesions is a current trend in neurosurgery. Regarding epilepsy, neuromodulation is currently under intensive research. The field is growing at a fast pace every day. This work has the purpose of reviewing the various targets that have been stimulated in the search of the possibility to control refractory seizures. A consideration is made of how the different targets and patients are selected: seizure outcomes and adverse effects. Targets can be chosen with the idea to interfere with seizure propagation; this is the case of cerebellar, vagal, subthalamic, and thalamic stimulation. Currently, studies are being performed stimulating the epileptic focus. Even though many controversies regarding which is the best target and stimulating parameters still exist, there is no doubt neuromodulation reduces seizures and has the advantage of being reversible and safe.

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References

  • Avoli M, Gloor P, Kostopoulus G, Gutman J. An analysis of penicillin-induced generalized spike and wave discharges using simultaneous recording of cortical and thalamic single neurons. J Neurophysiol. 1983;50:819–37.

    PubMed  CAS  Google Scholar 

  • Babb TL, Soper HV, Lieb JP, Brown WJ, Ottino CA, Crandall PH. Electrophysiological studies of long-term electrical stimulation of the cerebellum in monkeys. J Neurosurg. 1977;47:353–65.

    Article  PubMed  CAS  Google Scholar 

  • Ben-Menachem E. Vagus-nerve stimulation for the treatment of epilepsy. Lancet Neurol. 2002;1:477–82.

    Article  PubMed  Google Scholar 

  • Berg AT, Vickrey BG, Langfitt JT, Sperling MR, Walczak TS, Shinnar S, et al. Multicenter study of epilepsy surgery. The multicenter study of epilepsy surgery: recruitment and selection for surgery. Epilepsia. 2003;44:1425–33.

    Article  PubMed  Google Scholar 

  • Boon P, Vonck K, De Herdt V, Van Dycke A, Goethals M, Goossens L, et al. Deep brain stimulation in patients with refractory temporal lobe epilepsy. Epilepsia. 2007;48:1551–60.

    Article  PubMed  Google Scholar 

  • Chabardes S, Kahane P, Minotti L, Koudsie A, Hirsch E, Benabid AL. Deep brain stimulation in epilepsy with particular reference to the subthalamic nucleus. Epileptic Disord. 2002;4:S83–93.

    PubMed  Google Scholar 

  • Cooper IS. Cerebellar stimulation in man. New York: Raven; 1978. p. 3–265.

    Google Scholar 

  • Cooper IS, Amin I, Gilman S. The effect of chronic cerebellar stimulation upon epilepsy in man. Trans Am Neurol Assoc. 1973;98:192–6.

    PubMed  CAS  Google Scholar 

  • Cooper IS, Amin I, Riklan M, Waltz JM, Poon TP. Chronic cerebellar stimulation in epilepsy. Clinical and anatomical studies. Arch Neurol. 1976;33:559–70.

    Article  PubMed  CAS  Google Scholar 

  • Cuellar-Herrera M, Velasco M, Velasco F, Velasco AL, Jimenez F, Orozco S, et al. Evaluation of GABA system and cell damage in parahippocampus of patients with temporal lobe epilepsy showing antiepileptic effects after subacute electrical stimulation. Epilepsia. 2004;45(5):459–66.

    Article  PubMed  CAS  Google Scholar 

  • Davis R, Emmonds SE. Cerebellar stimulation for seizure control: 17-year study. Stereotact Funct Neurosurg. 1992;58:200–8.

    Article  PubMed  CAS  Google Scholar 

  • Dow RS, Fernandez-Guardiola A, Manni E. The influence of the cerebellum on experimental epilepsy. Electroencephalogr Clin Neurophysiol. 1962;14:383–98.

    Article  PubMed  CAS  Google Scholar 

  • Ebner TJ, Bantli H, Bloedel JR. Effects of cerebellar stimulation on unitary activity within a chronic epileptic focus in a primate. Electroencephalogr Clin Neurophysiol. 1980;49:585–99.

    Article  PubMed  CAS  Google Scholar 

  • Fisher R, Salanova V, Witt T, Worth R, Henry T, Gross R, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy Epilepsia. 2010;51:899–908.

    Google Scholar 

  • Fountas KN, Smith JR. A novel closed-loop stimulation system in the control of focal, medically refractory epilepsy. Acta Neurochir Suppl. 2007;97:357–62.

    Article  PubMed  CAS  Google Scholar 

  • Gale K, Iadarola MJ. Seizure protection and increased nerve-terminal GABA: delayed effects of GABA transaminase inhibition. Science. 1980;208:288–91.

    Article  PubMed  CAS  Google Scholar 

  • George MS, Nahas Z, Bohning DE, Lomarev M, Denslow S, Osenbach R, et al. Vagus nerve stimulation: a new form of therapeutic brain stimulation. CNS Spectr. 2000;5:43–52.

    PubMed  CAS  Google Scholar 

  • Gloor P, Quesney LF, Zumstein H. Pathophysiology of generalized penicillin seizures in the cat. The role of cortical and subcortical structures II topical application of penicillin to the cerebral cortex and subcortical structures. Electroencephalogr Clin Neurophysiol. 1997;48:79–94.

    Google Scholar 

  • Iatawa K, Snider RS. Cerebello-hippocampal influences on the electroencephalogram. Appl Neurophysiol. 1959;11:439–46.

    Google Scholar 

  • Miller JW, Farandelli JA. The central medial nucleus: thalamic site of seizure regulation. Brain Res. 1990;508:297–300.

    Article  PubMed  CAS  Google Scholar 

  • Mirski MA, Fisher RS. Electrical stimulation of the mammillary nuclei increases seizure threshold to pentylenetetrazol in rats. Epilepsia. 1994;35:1309–16.

    Article  PubMed  CAS  Google Scholar 

  • Moruzzi G. Sui rapporti fra cervelleto e corteccia cerebrale: Azione d’impulse cerebellari sulle attivita motriciti provocate della stimulazione farandica o chimica del giro sigmoldeo nel gato. Arch Fisiol. 1941;41:157–82.

    Google Scholar 

  • Nuche-Bricaire A, Montes De Oca M, Marcos-Ortega M, Trejo D, Núñez JM, Vazquez D, Velasco AL. Voltage-dependant verbal memory. Effects on the cognitive function through changing voltage parameters in deep brain stimulation. Proceedings of the 64th American epilepsy society meeting, San Antonio, USA, December 2010.

    Google Scholar 

  • Osorio I, Frei MG, Manly BF, Sunderam S, Bhavaraju NC, Wilkinson SB. An introduction to contingent (closed-loop) brain electrical stimulation for seizure blockage, to ultra-short-term clinical trials, and to multidimensional statistical analysis of therapeutic efficacy. J Clin Neurophysiol. 2001;18:533–44.

    Article  PubMed  CAS  Google Scholar 

  • Penfield W, Jasper H. Epilepsy and the functional anatomy of the human brain. Boston: Little Brown; 1954.

    Google Scholar 

  • Pollen DA, Perot P, Reid KH. Experimental bilateral spike and wave from thalamic stimulation in relation to the level of arousal. Electroencephalogr Clin Neurophysiol. 1963;15:459–73.

    Google Scholar 

  • Sun FT, Morrell MJ, Wharen REJ. Responsive cortical stimulation for the treatment of epilepsy. Neurotherapeutics. 2008;5:68–74.

    Article  PubMed  Google Scholar 

  • Velasco F, Velasco M, Romo R. Specific and nonspecific multiple unit activities during pentylenetetrazol seizures in animal with mesencephalic transections. Electroencephalogr Clin Neurophysiol. 1982;53:289–97.

    Article  PubMed  CAS  Google Scholar 

  • Velasco F, Velasco M, Ogarrio C, Fanghanel G. Electrical stimulation of the centromedian thalamic nucleus in the treatment of convulsive seizures: a preliminary report. Epilepsia. 1987;28:421–30.

    Article  PubMed  CAS  Google Scholar 

  • Velasco F, Velasco M. Mesencephalic structures and tonic clonic generalized seizures. In: Avoli M, Gloor P, Kustopoulus G, Naquet R, editors. Generalized epilepsy. Neurobiological approaches. Boston: Birkhouser; 1990, p. 368–84.

    Google Scholar 

  • Velasco M, Velasco F, Velasco AL, Velasco G, Jimenez F. Effect of chronic electrical stimulation of the centromedian thalamic nuclei on various intractable seizure patterns: II. Psychological performance and background EEG activity. Epilepsia. 1993;34:1065–74.

    Article  PubMed  CAS  Google Scholar 

  • Velasco M, Velasco F, Velasco AL, Brito F, Jimenez F, Marquez I, et al. Electrocortical and behavioral responses produced by acute electrical stimulation of the human centromedian thalamic nucleus. Electroencephalogr Clin Neurophysiol. 1997;102:461–71.

    Article  PubMed  CAS  Google Scholar 

  • Velasco AL, Velasco M, Velasco F, Menes D, Gordon F, Rocha L, et al. Subacute and chronic electrical stimulation of the hippocampus on intractable temporal lobe seizures: preliminary report. Arch Med Res. 2000a;31:316–28.

    Article  PubMed  CAS  Google Scholar 

  • Velasco F, Velasco M, Jimenez F, Velasco AL, Brito F, Rise M, et al. Predictors in the treatment of difficult-to-control seizures by electrical stimulation of the centromedian thalamic nucleus. Neurosurgery. 2000b;47:295–304.

    Article  PubMed  CAS  Google Scholar 

  • Velasco F, Carrillo-Ruiz JD, Brito F, Velasco M, Velasco AL, Marquez I, et al. Double-blind, randomized controlled pilot study of bilateral cerebellar stimulation for treatment of intractable motor seizures. Epilepsia. 2005;46:1071–81.

    Article  PubMed  Google Scholar 

  • Velasco AL, Velasco F, Jimenez F, Velasco M, Castro G, Carrillo-Ruiz JD, et al. Neuromodulation of the centromedian thalamic nuclei in the treatment of generalized seizures and the ­improvement of the quality of life in patients with Lennox-Gastaut syndrome. Epilepsia. 2006;47:1203–12.

    Article  PubMed  Google Scholar 

  • Velasco AL, Velasco F, Velasco M, Trejo D, Castro G, Carrillo-Ruiz JD. Electrical stimulation of the hippocampal epileptic foci for seizure control: a double-blind, long-term follow-up study. Epilepsia. 2007;48:1895–903.

    Article  PubMed  Google Scholar 

  • Velasco AL, Velasco F, Velasco M, Nuñez JM, Trejo D, Garcia I. Neuromodulation of epileptic foci in patients with non-lesional refractory motor epilepsy. Int J Neural Syst. 2009;19:139–47.

    Article  PubMed  Google Scholar 

  • Vesper J, Steinhoff B, Rona S, Wille C, Bilic S, Nikkhah G, et al. Chronic high-frequency deep brain stimulation of the STN/SNr for progressive myoclonic epilepsy. Epilepsia. 2007;48:1984–9.

    Article  PubMed  Google Scholar 

  • Weiss SR, Eidsath A, Li XL, Heynen T, Post RM. Quenching revisited: low level direct current inhibits amygdala-kindled seizures. Exp Neurol. 1998;154:185–92.

    Article  PubMed  CAS  Google Scholar 

  • Wyckhuys T, De Smedt T, Claeys P, Raedt R, Waterschoot L, Vonck K, et al. High frequency deep brain stimulation in the hippocampus modifies seizure characteristics in kindled rats. Epilepsia. 2007;48:1543–50.

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology and Neurosurgery, General Hospital of Mexico, CDA, Bosques de Moctezuma 55 La Herradura, Huixquilucan, Mexico State, 52784, Mexico

    Ana Luisa Velasco & Francisco Velasco

Authors
  1. Ana Luisa Velasco
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  2. Francisco Velasco
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Correspondence to Ana Luisa Velasco .

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Editors and Affiliations

  1. , Pharmacobiology Department, Center for Research and Advanced Studies, Av. Instituto Politécnico Nacional 2508, Mexico City, 07360, Mexico

    Luisa Rocha

  2. , Disciplina de Neurologia Experimental, UNIFESP/EPM, Rua Botucatu 740, São Paulo, 04023-900, Brazil

    Esper A. Cavalheiro

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Velasco, A.L., Velasco, F. (2013). The Role of Neuromodulation in the Treatment of Refractory Epilepsy. In: Rocha, L., Cavalheiro, E. (eds) Pharmacoresistance in Epilepsy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6464-8_17

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