Perspectives on the current developments with neuromodulation for the treatment of epilepsy

ABSTRACT

Introduction: As deep brain stimulation revolutionized the treatment of movement disorders in the late 80s, neuromodulation in the treatment of epilepsy will undoubtedly undergo transformative changes in the years to come with the exponential growth of technological development moving into mainstream practice; the appearance of companies such as Facebook, Google, Neuralink within the realm of brain–computer interfaces points to this trend.

Areas covered: This perspective piece will talk about the history of brain stimulation in epilepsy, current-approved treatments, technical developments and the future of neurostimulation.

Expert opinion: Further understanding of the brain alongside machine learning and innovative technology will be the future of neuromodulation for the treatment of epilepsy. All of these innovations and advances should pave the way toward overcoming the vexing underutilization of surgery in the therapeutic armamentarium against medically refractory seizures, given the implicit advantage of a neuromodulatory rather than neurodestructive approach.

KEYWORDS:

• Epilepsy
• stimulation
• neuromodulation
• deep brain stimulation (DBS)
• responsive neurostimulation (RNS)
• artificial intelligence

Article highlights

• A considerable number of epilepsy patients who are drug-resistant will not be amenable to resective surgery due to either extensive networks, multifocal epilepsy or foci within eloquent cortex.

• Neuromodulation has become a therapeutic option in these patients, and a more attractive option that is less invasive than traditional ablative or resective surgeries.

• The growth of neurostimulation will be driven not only by theoretical research but by concomitant technology advancement.

• A greater understanding of brain anatomy and function coupled with artificial intelligence will be necessary to enhance the therapeutic benefit.

• The future of neurostimulation is smart neuromodulation.

Declaration of interest

N Jette receives an annual compensation for her work as an Associate Editor of Epilepsia. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.