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ABSTRACT
Introduction: Approximately one third of patients with focal epilepsy continue to have ongoing seizures despite adequate trials of anti-seizure medications. Surgery to remove the epileptogenic zone remains the most efficacious treatment option for focal drug-resistant epilepsy. However, when cortical areas are eloquent or there are multiple epileptogenic zones, surgical resection is not an ideal approach. Cortical stimulation provides an attractive alternative.
Area covered: Here, the authors describe Chronic Subthreshold Cortical Stimulation (CSCS), which uses continuous intracranial electrical stimulation applied near the epileptogenic zone to lower seizure probability. The authors review literature related to CSCS. One challenge is finding the most efficacious set of stimulation parameters for each patient.
Expert commentary: Data supporting CSCS are limited but promising for the treatment of patients with focal drug resistant epilepsy who are not surgical candidates. Additional electrophysiological biomarkers to estimate cortical excitability are needed.
Declaration of interest
M. Stead, G. Worrell and J.J. Van Gompel report support from NIH funded public-private-partnership grant (UH2-NS095495: Neurophysiologically Based Brain State Tracking & Modulation in Focal Epilepsy) between Mayo Clinic and Medtronic and a Medtronic supported Investigational device exemption study (Chronically-recorded deep brain nuclei/hippocampal high frequency oscillations as biomarkers of neurologic disease). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.