Neuromodulation for Drug-Resistant Epilepsy
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Questions and Answers

What proportion of epilepsy patients are estimated to be resistant to medical therapy?

  • 10%
  • 40%
  • 30% (correct)
  • 20%

    • What is Trigeminal Nerve Stimulation (TNS)?

  • A surgical procedure for epilepsy patients
  • A type of seizure
  • A non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy (correct)
  • A medication used to treat epilepsy

    • What is the role of the thalamus in the epilepsy network?

  • It is a medication used to treat epilepsy
  • It is a type of neuromodulation technique
  • It is a type of seizure
  • It is a key subcortical structure implicated in the epilepsy network (correct)

    • What is the Papez Circuit?

    <p>A neural circuit implicated in seizure propagation</p> Signup and view all the answers

    What is the primary mechanism of action of Deep Brain Stimulation (DBS) for epilepsy?

    <p>Inhibition of GABAergic neurons</p> Signup and view all the answers

    What is Responsive Neurostimulation (RNS)?

    <p>A type of neuromodulation technique</p> Signup and view all the answers

    What is the median seizure reduction observed in patients with intractable focal onset epilepsy treated with Responsive Neurostimulation (RNS)?

    <p>75%</p> Signup and view all the answers

    What is the most established target for epilepsy in open loop stimulation of the thalamus?

    <p>Anterior nucleus of the thalamus (ANT)</p> Signup and view all the answers

    What is the advantage of closed loop stimulation over open loop stimulation in epilepsy treatment?

    <p>All of the above</p> Signup and view all the answers

    What is the main disadvantage of closed loop stimulation for epilepsy treatment?

    <p>Insufficient understanding of optimal stimulation parameters and electrode selection</p> Signup and view all the answers

    What is the potential benefit of combined open and closed loop Deep Brain Stimulation (DBS) and Responsive Neurostimulation (RNS) in epilepsy treatment?

    <p>All of the above</p> Signup and view all the answers

    What percentage of patients with epilepsy are estimated to be resistant to medical therapy?

    <p>30%</p> Signup and view all the answers

    What is the role of the thalamus in seizure propagation?

    <p>It is a sensory relay center with widespread synaptic connectivity to many cortical regions.</p> Signup and view all the answers

    Which neuromodulation technique initiates stimulation in response to the detection of an epileptic event electrographically?

    <p>Responsive Neurostimulation (RNS)</p> Signup and view all the answers

    What is the most established target for epilepsy in open loop stimulation of the thalamus?

    <p>Anterior nucleus of the thalamus (ANT)</p> Signup and view all the answers

    Which neuromodulation technique is a non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy?

    <p>Trigeminal Nerve Stimulation (TNS)</p> Signup and view all the answers

    Which thalamic nucleus is a desirable target for neuromodulation due to its connectivity with the anterior cingulate gyrus and its role in seizure propagation?

    <p>Centromedian nucleus (CM)</p> Signup and view all the answers

    Which neuromodulation technique has been approved by the FDA for patients with refractory partial-onset seizures, with and without generalization, who are 18 years of age or older?

    <p>Deep Brain Stimulation (DBS)</p> Signup and view all the answers

    Which thalamic nucleus has been shown to reduce seizure frequency in some patients and is a newer target for epilepsy treatment?

    <p>Medial pulvinar (MP)</p> Signup and view all the answers

    Which neuromodulation technique is a closed-loop system that may improve efficacy and reduce side effects?

    <p>Vagus Nerve Stimulation (VNS)</p> Signup and view all the answers

    What is the primary mechanism of action of Deep Brain Stimulation (DBS) for epilepsy treatment?

    <p>Inhibition of GABAergic neurons</p> Signup and view all the answers

    Which neuromodulation technique involves directly stimulating or impeding neuronal action potential conduction through various mechanisms, including chemical, mechanical, thermal, optogenetic, magnetic, and electrical manipulation, with electrical stimulation being the most widely used?

    <p>Deep Brain Stimulation (DBS)</p> Signup and view all the answers

    What is the primary advantage of closed loop stimulation over open loop stimulation in neuromodulation for epilepsy treatment?

    <p>It provides a more personalized approach to care by configuring stimulation in response to the patient’s specific needs and epileptic activity.</p> Signup and view all the answers

    What percentage of patients with epilepsy are estimated to be resistant to medical therapy?

    <p>20-30%</p> Signup and view all the answers

    Which of the following is a viable option for refractory epilepsy?

    <p>Neuromodulation techniques</p> Signup and view all the answers

    Which neuromodulation technique is a non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy with strong evidence for safety and efficacy?

    <p>Trigeminal Nerve Stimulation (TNS)</p> Signup and view all the answers

    What is the role of the thalamus in the propagation of abnormal epileptiform activity?

    <p>It is a sensory relay center</p> Signup and view all the answers

    What is the most established target for epilepsy in open loop stimulation of the thalamus?

    <p>Anterior nucleus of the thalamus (ANT)</p> Signup and view all the answers

    What is the key component of the Papez Circuit, whose role in seizure propagation has been extensively explored?

    <p>Anterior nucleus of the thalamus (ANT)</p> Signup and view all the answers

    What is the closed-loop neuromodulation system that initiates stimulation in response to the detection of an epileptic event electrographically and has demonstrated a 75% median seizure reduction in patients with intractable focal onset epilepsy?

    <p>Responsive Neurostimulation (RNS)</p> Signup and view all the answers

    Which of the following is a contraindication for Deep Brain Stimulation (DBS) in patients with refractory partial-onset seizures?

    <p>All of the above</p> Signup and view all the answers

    What is the newer technology that may improve efficacy and reduce side effects of Vagus Nerve Stimulation (VNS)?

    <p>Closed-loop VNS</p> Signup and view all the answers

    What is the novel promising target for DBS in epilepsy patients that has been successfully treated with Responsive Neurostimulation (RNS)?

    <p>Medial pulvinar (MP)</p> Signup and view all the answers

    What is the key advantage of closed loop stimulation over open loop stimulation?

    <p>It carries a lower burden of stimulation</p> Signup and view all the answers

    What is the main disadvantage of closed loop stimulation?

    <p>It is limited by our current insufficient understanding of optimal stimulation parameters and electrode selection</p> Signup and view all the answers

    Which of the following is a viable option for patients with drug-resistant epilepsy who are not candidates for resection or ablation?

    <p>Neuromodulation</p> Signup and view all the answers

    What is Trigeminal Nerve Stimulation (TNS)?

    <p>A non-invasive, transcutaneous stimulation modality</p> Signup and view all the answers

    Which neuromodulation technique is a closed-loop system that initiates stimulation in response to the detection of an epileptic event electrographically?

    <p>Responsive Neurostimulation (RNS)</p> Signup and view all the answers

    What is the role of the thalamus in the epilepsy network?

    <p>It is a key subcortical structure implicated in the epilepsy network</p> Signup and view all the answers

    What is the most established target for epilepsy in open loop stimulation of the thalamus?

    <p>The anterior nucleus of the thalamus (ANT)</p> Signup and view all the answers

    What is the newest promising target for deep brain stimulation (DBS) in epilepsy patients?

    <p>The median pulvinar thalamic nucleus</p> Signup and view all the answers

    What is the prevalence of epilepsy in the general population?

    <p>1-2%</p> Signup and view all the answers

    What is the FDA-approved indication for deep brain stimulation (DBS) in epilepsy patients?

    <p>Patients with refractory complex partial seizures</p> Signup and view all the answers

    What is the proposed mechanism of action for deep brain stimulation (DBS) in reducing seizures?

    <p>Inhibition and activation of GABAergic neurons</p> Signup and view all the answers

    What is the difference between open loop and closed loop stimulation in epilepsy treatment?

    <p>Closed loop stimulation lacks the capability to personalize therapy</p> Signup and view all the answers

    What is the potential benefit of closed loop stimulation in epilepsy treatment?

    <p>It carries a lower burden of stimulation and fewer stimulation related side effects</p> Signup and view all the answers

    What is the potential limitation of closed loop stimulation in epilepsy treatment?

    <p>It is limited by our current insufficient understanding of optimal stimulation parameters and electrode selection</p> Signup and view all the answers

    What is the prevalence of epilepsy in the general population?

    <p>0.5-1%</p> Signup and view all the answers

    What is the main reason for using neuromodulation in the management of drug-resistant epilepsy?

    <p>Patients are not candidates for resection or ablation</p> Signup and view all the answers

    Which of the following is a non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy?

    <p>Trigeminal Nerve Stimulation (TNS)</p> Signup and view all the answers

    What is the role of the thalamus in the epilepsy network?

    <p>A key subcortical structure implicated in the epilepsy network</p> Signup and view all the answers

    What is the mechanism of action of Deep Brain Stimulation (DBS) in reducing seizures in patients with drug-resistant epilepsy?

    <p>Largely unknown and complex</p> Signup and view all the answers

    Which thalamic nucleus is a key component of the Papez Circuit and implicated in seizure propagation?

    <p>Anterior nucleus of the thalamus (ANT)</p> Signup and view all the answers

    Which of the following is a closed-loop neuromodulation system that initiates stimulation in response to the detection of an epileptic event electrographically?

    <p>Responsive Neurostimulation (RNS)</p> Signup and view all the answers

    What is the main advantage of closed loop stimulation over open loop stimulation?

    <p>Lower burden of stimulation, fewer stimulation related side effects, fewer cognitive and mood disruptions, and records chronic ambulatory EEG data</p> Signup and view all the answers

    Which of the following is a newer promising target for DBS in epilepsy patients?

    <p>Medial pulvinar thalamic nucleus (MP)</p> Signup and view all the answers

    Which of the following is a newer technology that may improve efficacy and reduce side effects of Vagus Nerve Stimulation (VNS)?

    <p>Closed-loop VNS</p> Signup and view all the answers

    What is the prevalence of drug-resistant epilepsy in patients with epilepsy?

    <p>30%</p> Signup and view all the answers

    What is the main advantage of Responsive Neurostimulation (RNS) over other neuromodulation techniques?

    <p>Detects and responds to seizure activity in real-time</p> Signup and view all the answers

    What is the prevalence of epilepsy in the general population?

    <p>1-2%</p> Signup and view all the answers

    What is neuromodulation?

    <p>Directly stimulating or impeding neuronal action potential conduction through various mechanisms</p> Signup and view all the answers

    What is the role of the thalamus in epilepsy?

    <p>It is a key subcortical structure implicated in the epilepsy network</p> Signup and view all the answers

    What is the most established target for epilepsy in open loop stimulation?

    <p>Anterior thalamic nucleus (ANT)</p> Signup and view all the answers

    What is the mechanism of action of DBS in epilepsy?

    <p>Largely unknown and complex</p> Signup and view all the answers

    Which neuromodulation technique has a heart rate-based seizure detection algorithm?

    <p>Vagus Nerve Stimulation (VNS)</p> Signup and view all the answers

    What is the success rate of RNS in treating intractable focal onset epilepsy?

    <p>75%</p> Signup and view all the answers

    What is the contraindication for DBS in epilepsy patients?

    <p>Incapability of operating the neurostimulator</p> Signup and view all the answers

    What is the newer target for DBS in epilepsy patients?

    <p>Median pulvinar thalamic nucleus</p> Signup and view all the answers

    What is the advantage of closed loop stimulation over open loop stimulation?

    <p>Lower burden of stimulation, fewer side effects, and personalized therapy</p> Signup and view all the answers

    Which thalamic nucleus is a desirable target for neuromodulation due to its connectivity with the anterior cingulate gyrus?

    <p>Centromedian nucleus (CM)</p> Signup and view all the answers

    What is the prevalence of drug-resistant epilepsy in patients with epilepsy?

    <p>30%</p> Signup and view all the answers

    What is the prevalence of epilepsy in the general population?

    <p>0.5-1%</p> Signup and view all the answers

    Which neuromodulation technique involves directly stimulating or impeding neuronal action potential conduction through various mechanisms?

    <p>Electrical manipulation</p> Signup and view all the answers

    What is the role of the thalamus in seizure propagation?

    <p>It is a sensory relay center with widespread synaptic connectivity to many cortical regions</p> Signup and view all the answers

    Which neuromodulation technique has demonstrated a 75% median seizure reduction in patients with intractable focal onset epilepsy?

    <p>Responsive Neurostimulation (RNS)</p> Signup and view all the answers

    What is the SANTE trial?

    <p>A trial of Deep Brain Stimulation for epilepsy</p> Signup and view all the answers

    Which thalamic nucleus is a key component of the Papez Circuit and implicated in seizure propagation?

    <p>Anterior nucleus of the thalamus (ANT)</p> Signup and view all the answers

    What is the main contraindication for Deep Brain Stimulation (DBS)?

    <p>Medical frailty and inability to undergo surgical implantation</p> Signup and view all the answers

    What is the mechanism of action of DBS in reducing seizures?

    <p>Inhibition of GABAergic neurons</p> Signup and view all the answers

    What is the main advantage of closed loop stimulation over open loop stimulation?

    <p>It records chronic ambulatory EEG data</p> Signup and view all the answers

    Which thalamic nucleus is a novel promising target for DBS in epilepsy patients?

    <p>Median pulvinar thalamic nucleus</p> Signup and view all the answers

    What is the main advantage of closed-loop Vagus Nerve Stimulation (VNS) over traditional VNS?

    <p>It may improve efficacy and reduce side effects</p> Signup and view all the answers

    What is the main advantage of TNS over VNS?

    <p>It is a non-invasive, transcutaneous stimulation modality</p> Signup and view all the answers

    Which of the following is a viable option for patients with drug-resistant epilepsy who are not candidates for resection or ablation?

    <p>Neuromodulation</p> Signup and view all the answers

    Which patients are candidates for neuromodulation for treatment of drug-resistant epilepsy?

    <p>Patients with generalized epilepsy</p> Signup and view all the answers

    Which neuromodulation technique is a non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy?

    <p>Trigeminal Nerve Stimulation (TNS)</p> Signup and view all the answers

    Which neuromodulation technique has been shown to significantly reduce seizures in patients with drug-resistant epilepsy and utilizes a closed loop stimulation approach using a heart rate-based seizure detection algorithm?

    <p>Vagus Nerve Stimulation (VNS)</p> Signup and view all the answers

    Which neuromodulation technique is a closed-loop system that initiates stimulation in response to the detection of an epileptic event electrographically and has demonstrated a 75% median seizure reduction in patients with intractable focal onset epilepsy?

    <p>Responsive Neurostimulation (RNS)</p> Signup and view all the answers

    Which neuromodulation technique has been shown to reduce seizures in patients with drug-resistant epilepsy and studies have highlighted the role of astrocyte activation in DBS by inducing local neuronal modulation?

    <p>Deep Brain Stimulation (DBS)</p> Signup and view all the answers

    Which thalamic nucleus is a key component of the Papez Circuit, whose role in seizure propagation has been extensively explored and is a desirable target for neuromodulation?

    <p>Anterior nucleus of thalamus (ANT)</p> Signup and view all the answers

    Which thalamic nucleus is a desirable target for neuromodulation due to its connectivity with the anterior cingulate gyrus, which is part of the Papez Circuit and implicated in seizure propagation?

    <p>Centromedian nucleus (CM)</p> Signup and view all the answers

    Which thalamic nucleus is a novel promising target for DBS in epilepsy patients and was successfully treated with Responsive Neurostimulation (RNS) for posterior quadrant epilepsy?

    <p>Medial pulvinar (MP)</p> Signup and view all the answers

    Which neuromodulation technique is a newer technology that may improve efficacy and reduce side effects of Vagus Nerve Stimulation (VNS) for epilepsy treatment?

    <p>Closed-loop VNS</p> Signup and view all the answers

    Which neuromodulation technique is a promising alternative to VNS and has been shown to reduce seizure frequency in some patients with refractory epilepsy?

    <p>Trigeminal Nerve Stimulation (TNS)</p> Signup and view all the answers

    What is the prevalence of epilepsy in the general population and what percentage of these patients are resistant to medical therapy?

    <p>Prevalence is 1% and 30% of patients are resistant to medical therapy</p> Signup and view all the answers

    What is the estimated prevalence of epilepsy in the general population?

    <p>1-2%</p> Signup and view all the answers

    Which patients are candidates for neuromodulation for drug-resistant epilepsy?

    <p>All of the above</p> Signup and view all the answers

    Which neuromodulation technique has demonstrated a 75% median seizure reduction in patients with intractable focal onset epilepsy?

    <p>Responsive Neurostimulation (RNS)</p> Signup and view all the answers

    What is the role of the thalamus in epilepsy?

    <p>All of the above</p> Signup and view all the answers

    What is the most established target for epilepsy in open loop stimulation of the thalamus?

    <p>Anterior nucleus of the thalamus (ANT)</p> Signup and view all the answers

    What is the FDA-approved use of Deep Brain Stimulation (DBS) for epilepsy?

    <p>Patients with refractory partial-onset seizures, with and without generalization, who are 18 years of age or older</p> Signup and view all the answers

    What is the contraindication for Deep Brain Stimulation (DBS) in epilepsy patients?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of Deep Brain Stimulation (DBS) for epilepsy?

    <p>It inhibits GABAergic neurons</p> Signup and view all the answers

    Which neuromodulatory technique is a non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy?

    <p>Trigeminal Nerve Stimulation (TNS)</p> Signup and view all the answers

    What is the newer technology for Vagus Nerve Stimulation (VNS) that may improve efficacy and reduce side effects?

    <p>Closed loop stimulation</p> Signup and view all the answers

    What is the newer target for Deep Brain Stimulation (DBS) in epilepsy patients that has shown potential in rodent models and in a single case study in a patient?

    <p>Median pulvinar thalamic nucleus</p> Signup and view all the answers

    What is the advantage of closed loop stimulation over open loop stimulation in neuromodulation for epilepsy?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Emerging Trends in Neuromodulation for Treatment of Drug-Resistant Epilepsy

    • Epilepsy affects over 70 million people globally and a significant proportion is resistant to anti-epileptic drugs.

    • Neuromodulation has emerged as a pivotal alternative in the management of drug-resistant epilepsy for patients who are not candidates for resection or ablation.

    • Candidates for neuromodulation include those who have seizure foci involving the eloquent cortex, decline traditional surgical resection, have multifocal or generalized epilepsy, or have continued seizures despite resection/ablation.

    • Trigeminal Nerve Stimulation (TNS) is a non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy with strong evidence for safety and efficacy.

    • Vagus Nerve Stimulation (VNS) has been shown to significantly reduce seizures in patients with drug-resistant epilepsy and recent advancements in VNS technology have allowed for the utilization of a closed loop stimulation approach using a heart rate-based seizure detection algorithm.

    • Responsive Neurostimulation (RNS) is a closed-loop neuromodulation system that initiates stimulation in response to the detection of an epileptic event electrographically and has demonstrated a 75% median seizure reduction in patients with intractable focal onset epilepsy.

    • Deep Brain Stimulation (DBS) has been shown to reduce seizures in patients with drug-resistant epilepsy and studies have highlighted the role of astrocyte activation in DBS by inducing local neuronal modulation.

    • The SANTE trial demonstrated the safety and efficacy of DBS in the anterior nucleus of thalamus stimulation for epilepsy and demonstrated continued improvement of efficacy over time.

    • The thalamus is a key subcortical structure implicated in the epilepsy network, making various nuclei desirable targets for neuromodulatory techniques.

    • The etiology of refractory epilepsy is complex and the prevalence of epilepsy in the general population is estimated to be ∼0.5–1%, with 30% of these patients being resistant to medical therapy.

    • TNS, VNS, RNS, and DBS are all viable options for refractory epilepsy with varying degrees of efficacy and safety.

    • Neuromodulation techniques involve directly stimulating or impeding neuronal action potential conduction through various mechanisms, including chemical, mechanical, thermal, optogenetic, magnetic, and electrical manipulation, with electrical stimulation being the most widely used.Neuromodulatory Trends for Intractable Epilepsy: Thalamic Stimulation Targets

    • Deep Brain Stimulation (DBS) was initially used as a diagnostic intervention to confirm target areas prior to lesioning.

    • DBS is now a widely used therapeutic intervention for conditions such as essential tremor, Parkinson's disease, and pain.

    • DBS has been approved by the FDA for patients with refractory partial-onset seizures, with and without generalization, who are 18 years of age or older.

    • DBS is contraindicated in patients who are incapable of operating the neurostimulator, have significant psychiatric contraindications, or are medically frail and unable to undergo surgical implantation.

    • The anti-epileptic mechanisms of DBS are largely unknown and complex, with proposed mechanisms including inhibition and activation of GABAergic neurons.

    • The thalamus is a sensory relay center with widespread synaptic connectivity to many cortical regions and plays a role in the propagation of abnormal epileptiform activity.

    • The anterior nucleus of the thalamus (ANT) is a key component of the Papez Circuit, whose role in seizure propagation has been extensively explored.

    • Direct electrical stimulation of the thalamus allows for modulation of neural circuitry and ultimately interferes with seizure propagation.

    • The centromedian nucleus (CM) is a desirable target for neuromodulation due to its connectivity with the anterior cingulate gyrus, which is part of the Papez Circuit and implicated in seizure propagation.

    • The median pulvinar thalamic nucleus is a novel promising target for DBS in epilepsy patients.

    • Responsive Neurostimulation (RNS) of the pulvinar was successful in treating posterior quadrant epilepsy.

    • Combined open and closed loop DBS and RNS have been studied in rodent models and in a single case study in a patient, showing potential for future neuromodulatory systems.Neuromodulatory Trends for Intractable Epilepsy

    • Neuromodulatory techniques have had significant success in treating epilepsy in patients who are refractory to medication or not suitable for traditional resective or ablative surgery.

    • Modulation of various thalamic nuclei, through open and closed loop systems, is an effective and safe option for these patients.

    • Open loop anterior thalamic nucleus (ANT) stimulation is the most established target for epilepsy.

    • Concurrent stimulation of multiple thalamic nuclei on seizure frequency is not well studied.

    • Closed loop stimulation carries a lower burden of stimulation, fewer stimulation related side effects, fewer cognitive and mood disruptions, and records chronic ambulatory EEG data.

    • Closed loop stimulation is useful in measuring seizure burden in response to changes in antiepileptic medications, behavior modification, and in characterizing neurobehavioral spells.

    • Open loop stimulation lacks the capability to personalize therapy.

    • Closed loop stimulation has the ability to provide a more personalized approach to care by configuring stimulation in response to the patient’s specific needs and epileptic activity.

    • Treatment decision making should be guided by patient specific factors.

    • Closed loop stimulation is limited by our current insufficient understanding of optimal stimulation parameters and electrode selection, which prevents maximal efficacy.

    • Future larger scale studies are needed to draw substantial conclusions on the effects of stimulation of more than one thalamic nucleus on seizure control.

    • Neuromodulatory techniques have the potential to significantly improve the quality of life for patients with medically resistant epilepsy.Neuromodulatory Trends for Intractable Epilepsy

    • Stimulation and neuromodulation are effective treatment options for epilepsy.

    • Vagus nerve stimulation (VNS) is a commonly used method for epilepsy treatment.

    • Long-term treatment with VNS has been shown to reduce seizure frequency.

    • Closed-loop VNS is a newer technology that may improve efficacy and reduce side effects.

    • Trigeminal nerve stimulation (TNS) is a promising alternative to VNS.

    • TNS has been shown to reduce seizure frequency in some patients with refractory epilepsy.

    • Deep brain stimulation (DBS) of the thalamus is another option for epilepsy treatment.

    • DBS of the anterior nucleus of the thalamus (ANT) has been shown to reduce seizure frequency in some patients.

    • DBS of the centromedian nucleus (CM) and medial pulvinar (MP) are newer targets for epilepsy treatment.

    • Responsive neurostimulation (RNS) is a newer technology that detects and responds to seizure activity in real-time.

    • RNS has been shown to reduce seizure frequency in some patients with refractory epilepsy.

    • Further research is needed to fully understand the mechanisms and efficacy of these neuromodulatory treatments for epilepsy.

    Emerging Trends in Neuromodulation for Treatment of Drug-Resistant Epilepsy

    • Epilepsy affects over 70 million people globally and a significant proportion is resistant to anti-epileptic drugs.

    • Neuromodulation has emerged as a pivotal alternative in the management of drug-resistant epilepsy for patients who are not candidates for resection or ablation.

    • Candidates for neuromodulation include those who have seizure foci involving the eloquent cortex, decline traditional surgical resection, have multifocal or generalized epilepsy, or have continued seizures despite resection/ablation.

    • Trigeminal Nerve Stimulation (TNS) is a non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy with strong evidence for safety and efficacy.

    • Vagus Nerve Stimulation (VNS) has been shown to significantly reduce seizures in patients with drug-resistant epilepsy and recent advancements in VNS technology have allowed for the utilization of a closed loop stimulation approach using a heart rate-based seizure detection algorithm.

    • Responsive Neurostimulation (RNS) is a closed-loop neuromodulation system that initiates stimulation in response to the detection of an epileptic event electrographically and has demonstrated a 75% median seizure reduction in patients with intractable focal onset epilepsy.

    • Deep Brain Stimulation (DBS) has been shown to reduce seizures in patients with drug-resistant epilepsy and studies have highlighted the role of astrocyte activation in DBS by inducing local neuronal modulation.

    • The SANTE trial demonstrated the safety and efficacy of DBS in the anterior nucleus of thalamus stimulation for epilepsy and demonstrated continued improvement of efficacy over time.

    • The thalamus is a key subcortical structure implicated in the epilepsy network, making various nuclei desirable targets for neuromodulatory techniques.

    • The etiology of refractory epilepsy is complex and the prevalence of epilepsy in the general population is estimated to be ∼0.5–1%, with 30% of these patients being resistant to medical therapy.

    • TNS, VNS, RNS, and DBS are all viable options for refractory epilepsy with varying degrees of efficacy and safety.

    • Neuromodulation techniques involve directly stimulating or impeding neuronal action potential conduction through various mechanisms, including chemical, mechanical, thermal, optogenetic, magnetic, and electrical manipulation, with electrical stimulation being the most widely used.Neuromodulatory Trends for Intractable Epilepsy: Thalamic Stimulation Targets

    • Deep Brain Stimulation (DBS) was initially used as a diagnostic intervention to confirm target areas prior to lesioning.

    • DBS is now a widely used therapeutic intervention for conditions such as essential tremor, Parkinson's disease, and pain.

    • DBS has been approved by the FDA for patients with refractory partial-onset seizures, with and without generalization, who are 18 years of age or older.

    • DBS is contraindicated in patients who are incapable of operating the neurostimulator, have significant psychiatric contraindications, or are medically frail and unable to undergo surgical implantation.

    • The anti-epileptic mechanisms of DBS are largely unknown and complex, with proposed mechanisms including inhibition and activation of GABAergic neurons.

    • The thalamus is a sensory relay center with widespread synaptic connectivity to many cortical regions and plays a role in the propagation of abnormal epileptiform activity.

    • The anterior nucleus of the thalamus (ANT) is a key component of the Papez Circuit, whose role in seizure propagation has been extensively explored.

    • Direct electrical stimulation of the thalamus allows for modulation of neural circuitry and ultimately interferes with seizure propagation.

    • The centromedian nucleus (CM) is a desirable target for neuromodulation due to its connectivity with the anterior cingulate gyrus, which is part of the Papez Circuit and implicated in seizure propagation.

    • The median pulvinar thalamic nucleus is a novel promising target for DBS in epilepsy patients.

    • Responsive Neurostimulation (RNS) of the pulvinar was successful in treating posterior quadrant epilepsy.

    • Combined open and closed loop DBS and RNS have been studied in rodent models and in a single case study in a patient, showing potential for future neuromodulatory systems.Neuromodulatory Trends for Intractable Epilepsy

    • Neuromodulatory techniques have had significant success in treating epilepsy in patients who are refractory to medication or not suitable for traditional resective or ablative surgery.

    • Modulation of various thalamic nuclei, through open and closed loop systems, is an effective and safe option for these patients.

    • Open loop anterior thalamic nucleus (ANT) stimulation is the most established target for epilepsy.

    • Concurrent stimulation of multiple thalamic nuclei on seizure frequency is not well studied.

    • Closed loop stimulation carries a lower burden of stimulation, fewer stimulation related side effects, fewer cognitive and mood disruptions, and records chronic ambulatory EEG data.

    • Closed loop stimulation is useful in measuring seizure burden in response to changes in antiepileptic medications, behavior modification, and in characterizing neurobehavioral spells.

    • Open loop stimulation lacks the capability to personalize therapy.

    • Closed loop stimulation has the ability to provide a more personalized approach to care by configuring stimulation in response to the patient’s specific needs and epileptic activity.

    • Treatment decision making should be guided by patient specific factors.

    • Closed loop stimulation is limited by our current insufficient understanding of optimal stimulation parameters and electrode selection, which prevents maximal efficacy.

    • Future larger scale studies are needed to draw substantial conclusions on the effects of stimulation of more than one thalamic nucleus on seizure control.

    • Neuromodulatory techniques have the potential to significantly improve the quality of life for patients with medically resistant epilepsy.Neuromodulatory Trends for Intractable Epilepsy

    • Stimulation and neuromodulation are effective treatment options for epilepsy.

    • Vagus nerve stimulation (VNS) is a commonly used method for epilepsy treatment.

    • Long-term treatment with VNS has been shown to reduce seizure frequency.

    • Closed-loop VNS is a newer technology that may improve efficacy and reduce side effects.

    • Trigeminal nerve stimulation (TNS) is a promising alternative to VNS.

    • TNS has been shown to reduce seizure frequency in some patients with refractory epilepsy.

    • Deep brain stimulation (DBS) of the thalamus is another option for epilepsy treatment.

    • DBS of the anterior nucleus of the thalamus (ANT) has been shown to reduce seizure frequency in some patients.

    • DBS of the centromedian nucleus (CM) and medial pulvinar (MP) are newer targets for epilepsy treatment.

    • Responsive neurostimulation (RNS) is a newer technology that detects and responds to seizure activity in real-time.

    • RNS has been shown to reduce seizure frequency in some patients with refractory epilepsy.

    • Further research is needed to fully understand the mechanisms and efficacy of these neuromodulatory treatments for epilepsy.

    Emerging Trends in Neuromodulation for Treatment of Drug-Resistant Epilepsy

    • Epilepsy affects over 70 million people globally and a significant proportion is resistant to anti-epileptic drugs.

    • Neuromodulation has emerged as a pivotal alternative in the management of drug-resistant epilepsy for patients who are not candidates for resection or ablation.

    • Candidates for neuromodulation include those who have seizure foci involving the eloquent cortex, decline traditional surgical resection, have multifocal or generalized epilepsy, or have continued seizures despite resection/ablation.

    • Trigeminal Nerve Stimulation (TNS) is a non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy with strong evidence for safety and efficacy.

    • Vagus Nerve Stimulation (VNS) has been shown to significantly reduce seizures in patients with drug-resistant epilepsy and recent advancements in VNS technology have allowed for the utilization of a closed loop stimulation approach using a heart rate-based seizure detection algorithm.

    • Responsive Neurostimulation (RNS) is a closed-loop neuromodulation system that initiates stimulation in response to the detection of an epileptic event electrographically and has demonstrated a 75% median seizure reduction in patients with intractable focal onset epilepsy.

    • Deep Brain Stimulation (DBS) has been shown to reduce seizures in patients with drug-resistant epilepsy and studies have highlighted the role of astrocyte activation in DBS by inducing local neuronal modulation.

    • The SANTE trial demonstrated the safety and efficacy of DBS in the anterior nucleus of thalamus stimulation for epilepsy and demonstrated continued improvement of efficacy over time.

    • The thalamus is a key subcortical structure implicated in the epilepsy network, making various nuclei desirable targets for neuromodulatory techniques.

    • The etiology of refractory epilepsy is complex and the prevalence of epilepsy in the general population is estimated to be ∼0.5–1%, with 30% of these patients being resistant to medical therapy.

    • TNS, VNS, RNS, and DBS are all viable options for refractory epilepsy with varying degrees of efficacy and safety.

    • Neuromodulation techniques involve directly stimulating or impeding neuronal action potential conduction through various mechanisms, including chemical, mechanical, thermal, optogenetic, magnetic, and electrical manipulation, with electrical stimulation being the most widely used.Neuromodulatory Trends for Intractable Epilepsy: Thalamic Stimulation Targets

    • Deep Brain Stimulation (DBS) was initially used as a diagnostic intervention to confirm target areas prior to lesioning.

    • DBS is now a widely used therapeutic intervention for conditions such as essential tremor, Parkinson's disease, and pain.

    • DBS has been approved by the FDA for patients with refractory partial-onset seizures, with and without generalization, who are 18 years of age or older.

    • DBS is contraindicated in patients who are incapable of operating the neurostimulator, have significant psychiatric contraindications, or are medically frail and unable to undergo surgical implantation.

    • The anti-epileptic mechanisms of DBS are largely unknown and complex, with proposed mechanisms including inhibition and activation of GABAergic neurons.

    • The thalamus is a sensory relay center with widespread synaptic connectivity to many cortical regions and plays a role in the propagation of abnormal epileptiform activity.

    • The anterior nucleus of the thalamus (ANT) is a key component of the Papez Circuit, whose role in seizure propagation has been extensively explored.

    • Direct electrical stimulation of the thalamus allows for modulation of neural circuitry and ultimately interferes with seizure propagation.

    • The centromedian nucleus (CM) is a desirable target for neuromodulation due to its connectivity with the anterior cingulate gyrus, which is part of the Papez Circuit and implicated in seizure propagation.

    • The median pulvinar thalamic nucleus is a novel promising target for DBS in epilepsy patients.

    • Responsive Neurostimulation (RNS) of the pulvinar was successful in treating posterior quadrant epilepsy.

    • Combined open and closed loop DBS and RNS have been studied in rodent models and in a single case study in a patient, showing potential for future neuromodulatory systems.Neuromodulatory Trends for Intractable Epilepsy

    • Neuromodulatory techniques have had significant success in treating epilepsy in patients who are refractory to medication or not suitable for traditional resective or ablative surgery.

    • Modulation of various thalamic nuclei, through open and closed loop systems, is an effective and safe option for these patients.

    • Open loop anterior thalamic nucleus (ANT) stimulation is the most established target for epilepsy.

    • Concurrent stimulation of multiple thalamic nuclei on seizure frequency is not well studied.

    • Closed loop stimulation carries a lower burden of stimulation, fewer stimulation related side effects, fewer cognitive and mood disruptions, and records chronic ambulatory EEG data.

    • Closed loop stimulation is useful in measuring seizure burden in response to changes in antiepileptic medications, behavior modification, and in characterizing neurobehavioral spells.

    • Open loop stimulation lacks the capability to personalize therapy.

    • Closed loop stimulation has the ability to provide a more personalized approach to care by configuring stimulation in response to the patient’s specific needs and epileptic activity.

    • Treatment decision making should be guided by patient specific factors.

    • Closed loop stimulation is limited by our current insufficient understanding of optimal stimulation parameters and electrode selection, which prevents maximal efficacy.

    • Future larger scale studies are needed to draw substantial conclusions on the effects of stimulation of more than one thalamic nucleus on seizure control.

    • Neuromodulatory techniques have the potential to significantly improve the quality of life for patients with medically resistant epilepsy.Neuromodulatory Trends for Intractable Epilepsy

    • Stimulation and neuromodulation are effective treatment options for epilepsy.

    • Vagus nerve stimulation (VNS) is a commonly used method for epilepsy treatment.

    • Long-term treatment with VNS has been shown to reduce seizure frequency.

    • Closed-loop VNS is a newer technology that may improve efficacy and reduce side effects.

    • Trigeminal nerve stimulation (TNS) is a promising alternative to VNS.

    • TNS has been shown to reduce seizure frequency in some patients with refractory epilepsy.

    • Deep brain stimulation (DBS) of the thalamus is another option for epilepsy treatment.

    • DBS of the anterior nucleus of the thalamus (ANT) has been shown to reduce seizure frequency in some patients.

    • DBS of the centromedian nucleus (CM) and medial pulvinar (MP) are newer targets for epilepsy treatment.

    • Responsive neurostimulation (RNS) is a newer technology that detects and responds to seizure activity in real-time.

    • RNS has been shown to reduce seizure frequency in some patients with refractory epilepsy.

    • Further research is needed to fully understand the mechanisms and efficacy of these neuromodulatory treatments for epilepsy.

    Emerging Trends in Neuromodulation for Treatment of Drug-Resistant Epilepsy

    • Epilepsy affects over 70 million people globally and a significant proportion is resistant to anti-epileptic drugs.

    • Neuromodulation has emerged as a pivotal alternative in the management of drug-resistant epilepsy for patients who are not candidates for resection or ablation.

    • Candidates for neuromodulation include those who have seizure foci involving the eloquent cortex, decline traditional surgical resection, have multifocal or generalized epilepsy, or have continued seizures despite resection/ablation.

    • Trigeminal Nerve Stimulation (TNS) is a non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy with strong evidence for safety and efficacy.

    • Vagus Nerve Stimulation (VNS) has been shown to significantly reduce seizures in patients with drug-resistant epilepsy and recent advancements in VNS technology have allowed for the utilization of a closed loop stimulation approach using a heart rate-based seizure detection algorithm.

    • Responsive Neurostimulation (RNS) is a closed-loop neuromodulation system that initiates stimulation in response to the detection of an epileptic event electrographically and has demonstrated a 75% median seizure reduction in patients with intractable focal onset epilepsy.

    • Deep Brain Stimulation (DBS) has been shown to reduce seizures in patients with drug-resistant epilepsy and studies have highlighted the role of astrocyte activation in DBS by inducing local neuronal modulation.

    • The SANTE trial demonstrated the safety and efficacy of DBS in the anterior nucleus of thalamus stimulation for epilepsy and demonstrated continued improvement of efficacy over time.

    • The thalamus is a key subcortical structure implicated in the epilepsy network, making various nuclei desirable targets for neuromodulatory techniques.

    • The etiology of refractory epilepsy is complex and the prevalence of epilepsy in the general population is estimated to be ∼0.5–1%, with 30% of these patients being resistant to medical therapy.

    • TNS, VNS, RNS, and DBS are all viable options for refractory epilepsy with varying degrees of efficacy and safety.

    • Neuromodulation techniques involve directly stimulating or impeding neuronal action potential conduction through various mechanisms, including chemical, mechanical, thermal, optogenetic, magnetic, and electrical manipulation, with electrical stimulation being the most widely used.Neuromodulatory Trends for Intractable Epilepsy: Thalamic Stimulation Targets

    • Deep Brain Stimulation (DBS) was initially used as a diagnostic intervention to confirm target areas prior to lesioning.

    • DBS is now a widely used therapeutic intervention for conditions such as essential tremor, Parkinson's disease, and pain.

    • DBS has been approved by the FDA for patients with refractory partial-onset seizures, with and without generalization, who are 18 years of age or older.

    • DBS is contraindicated in patients who are incapable of operating the neurostimulator, have significant psychiatric contraindications, or are medically frail and unable to undergo surgical implantation.

    • The anti-epileptic mechanisms of DBS are largely unknown and complex, with proposed mechanisms including inhibition and activation of GABAergic neurons.

    • The thalamus is a sensory relay center with widespread synaptic connectivity to many cortical regions and plays a role in the propagation of abnormal epileptiform activity.

    • The anterior nucleus of the thalamus (ANT) is a key component of the Papez Circuit, whose role in seizure propagation has been extensively explored.

    • Direct electrical stimulation of the thalamus allows for modulation of neural circuitry and ultimately interferes with seizure propagation.

    • The centromedian nucleus (CM) is a desirable target for neuromodulation due to its connectivity with the anterior cingulate gyrus, which is part of the Papez Circuit and implicated in seizure propagation.

    • The median pulvinar thalamic nucleus is a novel promising target for DBS in epilepsy patients.

    • Responsive Neurostimulation (RNS) of the pulvinar was successful in treating posterior quadrant epilepsy.

    • Combined open and closed loop DBS and RNS have been studied in rodent models and in a single case study in a patient, showing potential for future neuromodulatory systems.Neuromodulatory Trends for Intractable Epilepsy

    • Neuromodulatory techniques have had significant success in treating epilepsy in patients who are refractory to medication or not suitable for traditional resective or ablative surgery.

    • Modulation of various thalamic nuclei, through open and closed loop systems, is an effective and safe option for these patients.

    • Open loop anterior thalamic nucleus (ANT) stimulation is the most established target for epilepsy.

    • Concurrent stimulation of multiple thalamic nuclei on seizure frequency is not well studied.

    • Closed loop stimulation carries a lower burden of stimulation, fewer stimulation related side effects, fewer cognitive and mood disruptions, and records chronic ambulatory EEG data.

    • Closed loop stimulation is useful in measuring seizure burden in response to changes in antiepileptic medications, behavior modification, and in characterizing neurobehavioral spells.

    • Open loop stimulation lacks the capability to personalize therapy.

    • Closed loop stimulation has the ability to provide a more personalized approach to care by configuring stimulation in response to the patient’s specific needs and epileptic activity.

    • Treatment decision making should be guided by patient specific factors.

    • Closed loop stimulation is limited by our current insufficient understanding of optimal stimulation parameters and electrode selection, which prevents maximal efficacy.

    • Future larger scale studies are needed to draw substantial conclusions on the effects of stimulation of more than one thalamic nucleus on seizure control.

    • Neuromodulatory techniques have the potential to significantly improve the quality of life for patients with medically resistant epilepsy.Neuromodulatory Trends for Intractable Epilepsy

    • Stimulation and neuromodulation are effective treatment options for epilepsy.

    • Vagus nerve stimulation (VNS) is a commonly used method for epilepsy treatment.

    • Long-term treatment with VNS has been shown to reduce seizure frequency.

    • Closed-loop VNS is a newer technology that may improve efficacy and reduce side effects.

    • Trigeminal nerve stimulation (TNS) is a promising alternative to VNS.

    • TNS has been shown to reduce seizure frequency in some patients with refractory epilepsy.

    • Deep brain stimulation (DBS) of the thalamus is another option for epilepsy treatment.

    • DBS of the anterior nucleus of the thalamus (ANT) has been shown to reduce seizure frequency in some patients.

    • DBS of the centromedian nucleus (CM) and medial pulvinar (MP) are newer targets for epilepsy treatment.

    • Responsive neurostimulation (RNS) is a newer technology that detects and responds to seizure activity in real-time.

    • RNS has been shown to reduce seizure frequency in some patients with refractory epilepsy.

    • Further research is needed to fully understand the mechanisms and efficacy of these neuromodulatory treatments for epilepsy.

    Emerging Trends in Neuromodulation for Treatment of Drug-Resistant Epilepsy

    • Epilepsy affects over 70 million people globally and a significant proportion is resistant to anti-epileptic drugs.

    • Neuromodulation has emerged as a pivotal alternative in the management of drug-resistant epilepsy for patients who are not candidates for resection or ablation.

    • Candidates for neuromodulation include those who have seizure foci involving the eloquent cortex, decline traditional surgical resection, have multifocal or generalized epilepsy, or have continued seizures despite resection/ablation.

    • Trigeminal Nerve Stimulation (TNS) is a non-invasive, transcutaneous stimulation modality for medication-resistant epilepsy with strong evidence for safety and efficacy.

    • Vagus Nerve Stimulation (VNS) has been shown to significantly reduce seizures in patients with drug-resistant epilepsy and recent advancements in VNS technology have allowed for the utilization of a closed loop stimulation approach using a heart rate-based seizure detection algorithm.

    • Responsive Neurostimulation (RNS) is a closed-loop neuromodulation system that initiates stimulation in response to the detection of an epileptic event electrographically and has demonstrated a 75% median seizure reduction in patients with intractable focal onset epilepsy.

    • Deep Brain Stimulation (DBS) has been shown to reduce seizures in patients with drug-resistant epilepsy and studies have highlighted the role of astrocyte activation in DBS by inducing local neuronal modulation.

    • The SANTE trial demonstrated the safety and efficacy of DBS in the anterior nucleus of thalamus stimulation for epilepsy and demonstrated continued improvement of efficacy over time.

    • The thalamus is a key subcortical structure implicated in the epilepsy network, making various nuclei desirable targets for neuromodulatory techniques.

    • The etiology of refractory epilepsy is complex and the prevalence of epilepsy in the general population is estimated to be ∼0.5–1%, with 30% of these patients being resistant to medical therapy.

    • TNS, VNS, RNS, and DBS are all viable options for refractory epilepsy with varying degrees of efficacy and safety.

    • Neuromodulation techniques involve directly stimulating or impeding neuronal action potential conduction through various mechanisms, including chemical, mechanical, thermal, optogenetic, magnetic, and electrical manipulation, with electrical stimulation being the most widely used.Neuromodulatory Trends for Intractable Epilepsy: Thalamic Stimulation Targets

    • Deep Brain Stimulation (DBS) was initially used as a diagnostic intervention to confirm target areas prior to lesioning.

    • DBS is now a widely used therapeutic intervention for conditions such as essential tremor, Parkinson's disease, and pain.

    • DBS has been approved by the FDA for patients with refractory partial-onset seizures, with and without generalization, who are 18 years of age or older.

    • DBS is contraindicated in patients who are incapable of operating the neurostimulator, have significant psychiatric contraindications, or are medically frail and unable to undergo surgical implantation.

    • The anti-epileptic mechanisms of DBS are largely unknown and complex, with proposed mechanisms including inhibition and activation of GABAergic neurons.

    • The thalamus is a sensory relay center with widespread synaptic connectivity to many cortical regions and plays a role in the propagation of abnormal epileptiform activity.

    • The anterior nucleus of the thalamus (ANT) is a key component of the Papez Circuit, whose role in seizure propagation has been extensively explored.

    • Direct electrical stimulation of the thalamus allows for modulation of neural circuitry and ultimately interferes with seizure propagation.

    • The centromedian nucleus (CM) is a desirable target for neuromodulation due to its connectivity with the anterior cingulate gyrus, which is part of the Papez Circuit and implicated in seizure propagation.

    • The median pulvinar thalamic nucleus is a novel promising target for DBS in epilepsy patients.

    • Responsive Neurostimulation (RNS) of the pulvinar was successful in treating posterior quadrant epilepsy.

    • Combined open and closed loop DBS and RNS have been studied in rodent models and in a single case study in a patient, showing potential for future neuromodulatory systems.Neuromodulatory Trends for Intractable Epilepsy

    • Neuromodulatory techniques have had significant success in treating epilepsy in patients who are refractory to medication or not suitable for traditional resective or ablative surgery.

    • Modulation of various thalamic nuclei, through open and closed loop systems, is an effective and safe option for these patients.

    • Open loop anterior thalamic nucleus (ANT) stimulation is the most established target for epilepsy.

    • Concurrent stimulation of multiple thalamic nuclei on seizure frequency is not well studied.

    • Closed loop stimulation carries a lower burden of stimulation, fewer stimulation related side effects, fewer cognitive and mood disruptions, and records chronic ambulatory EEG data.

    • Closed loop stimulation is useful in measuring seizure burden in response to changes in antiepileptic medications, behavior modification, and in characterizing neurobehavioral spells.

    • Open loop stimulation lacks the capability to personalize therapy.

    • Closed loop stimulation has the ability to provide a more personalized approach to care by configuring stimulation in response to the patient’s specific needs and epileptic activity.

    • Treatment decision making should be guided by patient specific factors.

    • Closed loop stimulation is limited by our current insufficient understanding of optimal stimulation parameters and electrode selection, which prevents maximal efficacy.

    • Future larger scale studies are needed to draw substantial conclusions on the effects of stimulation of more than one thalamic nucleus on seizure control.

    • Neuromodulatory techniques have the potential to significantly improve the quality of life for patients with medically resistant epilepsy.Neuromodulatory Trends for Intractable Epilepsy

    • Stimulation and neuromodulation are effective treatment options for epilepsy.

    • Vagus nerve stimulation (VNS) is a commonly used method for epilepsy treatment.

    • Long-term treatment with VNS has been shown to reduce seizure frequency.

    • Closed-loop VNS is a newer technology that may improve efficacy and reduce side effects.

    • Trigeminal nerve stimulation (TNS) is a promising alternative to VNS.

    • TNS has been shown to reduce seizure frequency in some patients with refractory epilepsy.

    • Deep brain stimulation (DBS) of the thalamus is another option for epilepsy treatment.

    • DBS of the anterior nucleus of the thalamus (ANT) has been shown to reduce seizure frequency in some patients.

    • DBS of the centromedian nucleus (CM) and medial pulvinar (MP) are newer targets for epilepsy treatment.

    • Responsive neurostimulation (RNS) is a newer technology that detects and responds to seizure activity in real-time.

    • RNS has been shown to reduce seizure frequency in some patients with refractory epilepsy.

    • Further research is needed to fully understand the mechanisms and efficacy of these neuromodulatory treatments for epilepsy.

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    Emerging Trends in Neuromodulation for Drug-Resistant Epilepsy PDF 2022

    Description

    Test your knowledge on the latest trends in neuromodulation for the treatment of drug-resistant epilepsy. This quiz will cover the various techniques of neuromodulation, such as trigeminal nerve stimulation (TNS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS), as well as their safety, efficacy, and potential for personalized care. You'll also learn about the different thalamic targets for neuromodulation and their

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