Neural Noise

Brain stimulation therapies for epilepsy

3 min read

  • The National Institute of Neurological Disorders and Stroke (NINDS) provides an overview of brain stimulation therapies for epilepsy 1.
  • Approaches include responsive and ablative stimulation and are relevant to neuromodulation and iEEG/stimulation devices 1. 1

Gardner updates

  • Thalamic neuromodulation is evolving for drug-resistant epilepsy, with implications for patient selection and closed-loop stimulation (NeuroVoices, Richard Rammo, MD). 2

Weekly enrichment (2026-07-20)

  • The NINDS overview credits NINDS-supported research in developing two FDA-approved brain-stimulation devices that reduce seizure frequency when medication alone fails: deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS, approved 2018) and responsive neurostimulation (RNS, approved 2013).3
  • Three implantable neurostimulation modalities are FDA-approved for drug-resistant epilepsy in patients who are poor resective-surgery candidates: vagus nerve stimulation (VNS, LivaNova, approved 1997), RNS (NeuroPace, 2013), and ANT-DBS (Medtronic, 2018); epilepsy is deemed drug-resistant after two appropriately chosen anti-seizure medications fail.4
  • RNS is a closed-loop device with a cranially mounted pulse generator that detects epileptiform activity and delivers stimulation directly to the seizure onset zone, whereas VNS and traditional DBS are open-loop, delivering continuous or scheduled stimulation; VNS leads sit extracranially around the vagus nerve while RNS and DBS require intracranial leads.4
  • An ILAE Surgical Therapies Commission systematic review and meta-analysis (Touma et al., Epilepsia 2022; 30 studies, 6 RCTs) reported RNS median seizure reduction of 53%, 66%, and 75% at 2, 5, and 9 years, and DBS reductions of 56%, 65%, and 75% at 2, 5, and 7 years.5
  • In the same meta-analysis, five VNS observational studies pooled to a 34.7% mean seizure reduction (95% CI -5.1 to 74.5) at a mean 1.3-year follow-up, and seizure-reduction rates across the three therapies were similar during the initial blinded phase.5
  • A 9-year prospective RNS study (256 patients treated, 230 in long-term follow-up) found a 75% median seizure reduction, a 73% responder rate, and 35% of patients achieving a >=90% reduction, with quality-of-life gains and a SUDEP rate significantly below predefined comparators.6
  • A 32-center US postapproval RNS study of 324 implanted adults (mean age 37.1, 59.6% female; 271 completed 3 years) reported median seizure reduction rising from 62% at 6 months to 82% at 3 years (p < 0.0001), with 41% achieving >=90% reduction and 42.5% having at least one seizure-free period of 6+ months.7
  • Common complications differ by device: hoarseness, cough, and throat pain for VNS versus implant-site pain, headache, and dysesthesia for RNS and DBS; the progressive, improving-over-time response of RNS and DBS contrasts with anti-seizure drugs and points to lasting neuromodulatory effects.5 4
  • For BCI and iEEG-based devices, RNS is notable as a chronic closed-loop platform that continuously records intracranial EEG and adapts stimulation, making it a template for detection-triggered neuromodulation relevant to this topic’s iEEG/stimulation focus.4

Footnotes

  1. https://news.google.com/rss/articles/CBMiywFBVV95cUxOV3E5VklUa3ZmcFJxa0J4QXBjS20tQkVoSlBYRUJVcTdxRm5SLVpCNEZBZWpNOHNFLTBHUHQ5V05rWDlBTTlkWG9UZXU2U0lVaHliWkF4VU9wTmhRaWxrTkxjUXdwaTJ5d0ZMNHlMNXNsNndSRDNZNTYyR2tWTi1KeEh3T0RzdXVXaElQcGpabWQtcE1NaWtKTmp3NkxTOXJRNkMydTBCWnhmU1dlaEhESnB6WnpnMjhLdUZCakVkV19RLTFiMjI4QlczOA?oc=5 ↩ ↩2 ↩3

  2. https://news.google.com/rss/articles/CBMivwFBVV95cUxQa1pNNjM2TFdjRjhCdjhKWGF0b3k1RFNEOWRma2x1XzFTZmo4SW9IaFNYbll3V2pkeUlzdjdEWlJnU3k0MWJWYi1WWGQ5aEI0TUd4QjRObnBMbDlTdWV5SUtzSEwwY2Q3SW14MnNMd08wZXhHZ0I5WkVQM3BaODBzdWtabGxTWVl2UDdVQjl2aVU5dmg5SDV0Q0xNUmlhdGRqMUlVa24zYjM2cDZqWUFRWGM4X3V5SDZPNE9Mc0ZKYw?oc=5 ↩

  3. https://www.ninds.nih.gov/about-ninds/what-we-do/impact/ninds-contributions-approved-therapies/brain-stimulation-therapies-epilepsy ↩

  4. https://pmc.ncbi.nlm.nih.gov/articles/PMC6554379/ ↩ ↩2 ↩3 ↩4

  5. https://onlinelibrary.wiley.com/doi/10.1111/epi.17243 ↩ ↩2 ↩3

  6. https://www.neurology.org/doi/10.1212/WNL.0000000000010154 ↩

  7. https://www.neurology.org/doi/10.1212/WNL.0000000000214875 ↩

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