Neuromodulation for the Treatment of Drug-Resistant Epilepsy

Abstract

Surgical neuromodulation for epilepsy refers to procedures involving the electrical stimulation of cortical, diencephalic, cerebellar and peripheral targets (such as the vagus nerve). Stereotactic radiosurgery also provides a neuromodulatory approach, affecting the discharging behavior of epileptic neurons in absence of evident target necrosis. Cortical transections or Multiple Subpial Transections (MST) are a non-resective technique useful to treat epileptogenic foci located in eloquent cortex. Electrical stimulation, stereotactic radiosurgery, and MST are emerging procedures for the treatment of medically refractory epilepsy in patients not amenable to resective surgery due to inability to map the focus, presence of multiple epileptogenic foci and/or involvement of eloquent cortex. Radiosurgery can also be offered to patients ineligible for invasive surgery for a variety of medical contraindications.