Purpose of Review: The purpose of this review is to provide an evidence-based update on the neurostimulation options available for patients with drug-resistant epilepsy in the United States and in European countries.
Recent Findings: The field of neurostimulation for epilepsy has grown dramatically since 1997, when vagus nerve stimulation became the first device to be approved for epilepsy by the US Food and Drug Administration (FDA). New data from recently completed randomized controlled trials are available for deep brain stimulation of the anterior thalamus, responsive neurostimulation, and trigeminal nerve stimulation. Although vagus nerve stimulation is the only device currently approved in the United States, deep brain stimulation and responsive neurostimulation devices are awaiting FDA approval. Deep brain stimulation, trigeminal nerve stimulation, and transcutaneous vagus nerve stimulation are now approved for epilepsy in the European Union. In this article, the mechanisms of action, safety, and efficacy of new neurostimulation devices are reviewed, and the key advantages and disadvantages of each are discussed.
Summary: The exponential growth of the field of neuromodulation for epilepsy is an exciting development; these new devices provide physicians with new options for patients with drug-resistant epilepsy.
Address correspondence to Dr Christopher M. DeGiorgio, Department of Neurology, David Geffen-UCLA School of Medicine, 710 Westwood Plaza, Los Angeles, CA 90095, firstname.lastname@example.org.
Relationship Disclosure: Dr DeGiorgio has stock options in and is an officer of NeuroSigma, Inc; is an inventor on patents licensed by the University of California, Los Angeles, to NeuroSigma, Inc; and receives grants from the NIH for trigeminal nerve stimulation. Dr Krahl has two pending patents owned by the University of California, Los Angeles, and the US Department of Veterans Affairs, licensed to NeuroSigma, Inc. Dr Krahl receives research support from Medtronic, Inc, and travel and research support from Brentwood Biomedical Research Institute, a nonprofit corporation affiliated with the US Department of Veterans Affairs.
Unlabeled Use of Products/Investigational Use Disclosure: Dr DeGiorgio and Dr Krahl discuss the unlabeled use of deep brain stimulation and responsive neurostimulation, and the investigational use of trigeminal nerve stimulation, for the treatment of epilepsy. Note: deep brain stimulation, responsive neurostimulation, and trigeminal nerve stimulation are limited by US federal law to investigational use only; deep brain stimulation and trigeminal nerve stimulation are approved for use in the European Union only.