Deep brain stimulation in the treatment of epilepsy
DOI:
https://doi.org/10.47924/neurotarget2008416Abstract
Epilepsy as a disease with a big incidence and prevalence (1.0 to 2.0% of population), chronic course, affect specially young population and frequently make disabilities and several difficulties in patients regarding social, work and intellect develop, the treatment of this population become as a health problem in all countries. Even more, despite of continuous investigation and research in the develop of new anticonvulsivants drugs, around 20% of patients do not get adequate control with the drugs. For these reasons, the alternative of surgical treatment for epileptic patients who cannot cannot be controlled with drugs is a necessity for a numerous group of patients. The surgical treatment for epilepsy has been developed for more than a century, changing from resection of brain orientated by the semiology of the seizure, to the concurrence of surface and intracranial electroencephalography (stereo-electroencephalography), simple and contrast radiology, computed tomography, simple, contrasted and functional magnetic resonance, single photon emission computed tomography, positron emission tomography and magnetoencephalography.
On the other hand, the analysis of hemisphere dominance through neuropsychological test and intravenous injection of drugs or brain mapping through electrode stimulation help to limit the surgical resections. All these methods have the aim to define the localization and extension of the seizure. Ideally, all have a concordance in the results, always guided by the semiology of the seizures. However, several times there is a discordance in the results, that could indicate that the epileptogenic area extends beyond
the clinic or electroencephalographic source or there is more than one convulsive source. Like this, the ablative surgery that tries to parch the epileptogenic area, may not be successful in an important number of cases that present a discordance in the diagnoses studies. Even more, in several patients is not possible to find the source of the seizures neither by the clinic, by electroencephalography nor by images.
The surgery that promotes damage with the purpose of isolate epileptogenic areas that cannot be parched due to the extension or to be located in primary regions, are associated with morbidity and also are less effective in the control of the seizures.
So far, the electric stimulation of nervous system has been performed in those cases that are not candidates for ablative surgery, that in our experience represents 20 to 30% of all potential cases for surgery. The most frequent causes to reject candidates for a surgery are multiples convulsive sources or symmetric bilateral in the hippocampus, the localization of the source in eloquent areas or if it is unable to determine the origin of the convulsive activity in cases of generalized seizures from the beginning.
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Copyright (c) 2008 Francisco Velasco, Marcos Velasco, Ana Luisa Velasco, Fiacro Jiménez, Francisco Brito, José María Núñez, Bernardo Boleaga, José Antonio Hernández, David Trejo, Luisa Rocha, Manola Cuellar
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.
