Despite the advent of new pharmacological treatments and the high success rate of many surgical treatments for epilepsy, a substantial number of patients either do not become seizure-free or they experience major adverse events (or both). Neurostimulation-based treatments have gained considerable interest in the last decade. Vagus nerve stimulation (VNS) is an alternative treatment for patients with medically refractory epilepsy, who are unsuitable candidates for conventional epilepsy surgery, or who have had such surgery without optimal outcome. Although responder identification studies are lacking, long-term VNS studies show response rates between 40% and 50% and long-term seizure freedom in 5% to 10% of patients. Surgical complications and perioperative morbidity are low. Research into the mechanism of action of VNS has revealed a crucial role for the thalamus and cortical areas that are important in the epileptogenic process. Acute deep brain stimulation (DBS) in various thalamic nuclei and medial temporal lobe structures has recently been shown to be efficacious in small pilot studies. There is little evidence-based information on rational targets and stimulation parameters. Amygdalohippocampal DBS has yielded a significant decrease of seizure counts and interictal EEG abnormalities during long-term follow-up. Data from pilot studies suggest that chronic DBS for epilepsy may be a feasible, effective, and safe procedure. Further trials with larger patient populations and with controlled, randomized, and closed-loop designs should now be initiated. Further progress in understanding the mechanism of action of DBS for epilepsy is a necessary step to making this therapy more efficacious and established.

中文翻译：

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电刺激用于治疗癫痫。


尽管出现了新的药物治疗方法，并且许多癫痫手术治疗的成功率很高，但仍有大量患者要么没有摆脱癫痫发作，要么经历了重大不良事件（或两者兼而有之）。在过去十年中，基于神经刺激的治疗引起了相当大的兴趣。迷走神经刺激 (VNS) 是医学难治性癫痫患者的一种替代治疗方法，这些患者不适合接受传统癫痫手术，或者接受过此类手术但效果不佳。尽管缺乏反应者识别研究，但长期 VNS 研究显示，反应率在 40% 至 50% 之间，并且 5% 至 10% 的患者长期无癫痫发作。手术并发症和围手术期发病率较低。 VNS 作用机制的研究揭示了丘脑和皮质区域在癫痫发生过程中的重要作用。最近的小型试点研究表明，对各种丘脑核和内侧颞叶结构进行急性深部脑刺激（DBS）是有效的。关于合理目标和刺激参数的循证信息很少。在长期随访过程中，杏仁核海马 DBS 显着减少了癫痫发作次数和发作间期脑电图异常。试点研究的数据表明，慢性 DBS 治疗癫痫可能是一种可行、有效且安全的手术。现在应该开始针对更多患者群体以及采用受控、随机和闭环设计的进一步试验。进一步了解 DBS 治疗癫痫的作用机制是使这种疗法更加有效和成熟的必要步骤。