Health Problem: Epilepsy is one of the most common neurological disorders in the United States and has a prevalence of approximately 3 million adults and 470,000 children. Management generally involves treatment with antiepileptic drugs (AEDs), but for approximately 30% of patients, seizures will remain uncontrolled by medical therapy. In these cases other, more invasive, procedures might be warranted, including intracranial surgery or neurostimulation with vagus nerve stimulation (VNS) or deep brain stimulation (DBS).
Technology Description: DBS is used as an adjunct to antiepileptic medications for partial-onset seizures (with or without secondary generalization) uncontrolled by medical management alone. DBS involves intracranial implantation of electrodes to deliver a programmed course of electrical stimulation to the anterior nucleus of the thalamus (ANT), a region of the brain implicated in seizure propagation. Stimulation or lesioning of the ANT may reduce seizure frequency and limit long-term complications due to uncontrolled seizures.
Controversy: Neurostimulation interventions such as DBS permit adjustable and reversible modulation of neural activity that leads to epileptic seizures. DBS of the ANT is proposed to significantly reduce seizure frequency in patients with refractory partial-onset seizures based on findings from several observational studies and a pivotal randomized controlled trial. However, evidence continues to emerge, and the efficacy and safety of DBS of the ANT for treatment of refractory, partial-onset seizures has yet to be determined.
Key Questions:
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Is DBS of the ANT effective in treating epilepsy for patients who have failed prior medical therapy?
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Is DBS of the ANT safe for the treatment of epilepsy, and are there long-term safety considerations for the implanted DBS device?
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Have definitive patient selection criteria been established for DBS of the ANT for the treatment of medically refractory epilepsy?
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