Clinical experience with vagus nerve stimulation and deep brain stimulation in epilepsy.

摘要: Patients with refractory epilepsy present a particular challenge to new therapies. Vagus nerve stimulation (VNS) for the control of intractable seizures has become available since 1989. VNS is relatively noninvasive treatment. It reduces seizure frequency by ≥50% in 1/3 patients; an additional patients experience worthwhile reduction between 30 and 50%. In remaining there little or no effect. Efficacy tendency improve longer duration treatment up 18 months postoperatively. Deep brain (DBS) direct electrical areas alternative neurostimulation modality. The cerebellum, various thalamic nuclei, pallidum, and, more recently, medial temporal lobe structures have been chosen as targets. DBS beyond stage proof-of-concept but still needs thorough evaluation confirmatory pilot studies before it can be offered larger patient populations. Analysis groups insight mode action may help identify epileptic syndromes that respond better either DBS. Randomized controlled series are mandatory potential population optimal paradigms. Further improvements clinical efficacy result from these studies.