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Samanta D, Haneef Z, Albert GW, Naik S, Reeders PC, Jain P, Abel TJ, Al-Ramadhani R, Ibrahim GM, Warren AEL. Neuromodulation strategies in developmental and epileptic encephalopathies. Epilepsy Behav 2024; 160:110067. [PMID: 39393142 DOI: 10.1016/j.yebeh.2024.110067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/19/2024] [Accepted: 09/28/2024] [Indexed: 10/13/2024]
Abstract
Developmental and epileptic encephalopathies (DEEs) are a group of childhood-onset epilepsy syndromes characterized by frequent seizures, severe cognitive and behavioral impairments, and poor long-term outcomes. These conditions are typically refractory to currently available medical therapies, prompting recent exploration of neuromodulation treatments such as deep brain stimulation (DBS) and responsive neurostimulation (RNS), which aim to modulate epileptic networks spanning cortical and subcortical regions. These advances have occurred alongside an improved understanding of syndrome-specific and interictal epileptiform discharge/seizure-specific brain networks. By targeting key nodes within these networks, DBS and RNS hold promise for influencing seizures and associated cognitive and behavioral comorbidities. Initial experiences with centromedian (CM) thalamic DBS for Lennox-Gastaut syndrome (LGS) have shown modest efficacy across multiple seizure types. Reports also indicate the application of DBS and RNS across various genetic and structural etiologies commonly associated with DEEs, with mixed success. Although DBS and RNS are increasingly used in LGS and other DEEs, their mixed efficacy highlights a knowledge gap in understanding why some patients with LGS do not respond and which neuromodulation approach is most effective for other DEEs. To address these issues, this review first discusses recent neuroimaging studies showing similarities and differences in the epileptic brain networks underlying various DEEs, revealing the common involvement of the thalamus and the default-mode network (DMN) across multiple DEEs. We then examine thalamic DBS for LGS to illustrate how such network insights may be used to optimize neuromodulation. Although network-based neuromodulation is still in its infancy, the LGS model may serve as a framework for other DEEs, where optimal treatment necessitates consideration of the underlying epileptic networks. Lastly, the review suggests future research directions, including individualized connectivity assessment and biomarker identification through collaborative efforts, which may enhance the therapeutic potential of neuromodulation for individuals living with DEEs.
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Affiliation(s)
- Debopam Samanta
- Division of Child Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Zulfi Haneef
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA; Neurology Care Line, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Gregory W Albert
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sunil Naik
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Puck C Reeders
- Brain Institute, Nicklaus Children's Hospital, Miami, FL, USA
| | - Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Taylor J Abel
- Departmen of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ruba Al-Ramadhani
- Division of Child Neurology, University of Pittsburgh, Department of Pediatrics, Pittsburgh, PA, USA
| | - George M Ibrahim
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Aaron E L Warren
- Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, MA 02115, USA
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Ali T, Amer M. Deep brain stimulation: a promising approach to revolutionize the treatment of pediatric epilepsy. Neurosurg Rev 2024; 47:682. [PMID: 39317780 DOI: 10.1007/s10143-024-02930-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 09/06/2024] [Accepted: 09/18/2024] [Indexed: 09/26/2024]
Abstract
A variety of treatment modalities currently exist for epilepsy, a debilitating disorder. With the emergence of drug-resistant epilepsy, however, new options are being explored. Deep brain stimulation is a neuromodulation technique that can prove to be a ground-breaking treatment option for pediatric epilepsy. It employs a neurosurgical method in which electrodes are implanted within the brain that send impulses to control abnormal brain activity. Significant gaps exist in literature, thereby emphasizing the importance of further research in this promising approach.
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Affiliation(s)
- Tooba Ali
- University College of Medicine and Dentistry, Lahore, Pakistan.
| | - Maham Amer
- University College of Medicine and Dentistry, Lahore, Pakistan
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Gouveia FV, Warsi NM, Suresh H, Matin R, Ibrahim GM. Neurostimulation treatments for epilepsy: Deep brain stimulation, responsive neurostimulation and vagus nerve stimulation. Neurotherapeutics 2024; 21:e00308. [PMID: 38177025 PMCID: PMC11103217 DOI: 10.1016/j.neurot.2023.e00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Epilepsy is a common and debilitating neurological disorder, and approximately one-third of affected individuals have ongoing seizures despite appropriate trials of two anti-seizure medications. This population with drug-resistant epilepsy (DRE) may benefit from neurostimulation approaches, such as vagus nerve stimulation (VNS), deep brain stimulation (DBS) and responsive neurostimulation (RNS). In some patient populations, these techniques are FDA-approved for treating DRE. VNS is used as adjuvant therapy for children and adults. Acting via the vagus afferent network, VNS modulates thalamocortical circuits, reducing seizures in approximately 50 % of patients. RNS uses an adaptive (closed-loop) system that records intracranial EEG patterns to activate the stimulation at the appropriate time, being particularly well-suited to treat seizures arising within eloquent cortex. For DBS, the most promising therapeutic targets are the anterior and centromedian nuclei of the thalamus, with anterior nucleus DBS being used for treating focal and secondarily generalized forms of DRE and centromedian nucleus DBS being applied for treating generalized epilepsies such as Lennox-Gastaut syndrome. Here, we discuss the indications, advantages and limitations of VNS, DBS and RNS in treating DRE and summarize the spatial distribution of neuroimaging observations related to epilepsy and stimulation using NeuroQuery and NeuroSynth.
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Affiliation(s)
| | - Nebras M Warsi
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hrishikesh Suresh
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rafi Matin
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - George M Ibrahim
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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