Electrical stimulation devices in the treatment of epilepsy.

Over the last ten years there has been a progressively increasing interest in the research and clinical application of implantable electrical brain stimulation devices in the treatment of drug-resistant epilepsy. The concept is not new, but the efforts were strengthened and accelerated after the efficacy of vagus nerve stimulation in controlling epilepsy was first demonstrated in the early 1990s and gained subsequently the approval of the USA Food and Drug Administration in 1997. This chapter reviews the progress made in this field. Special emphasis is given to the most important available evidence from animal and human studies, the neuroanatomical pathways and the role of the relevant neurotransmitters, the stimulation devices and the significance of correct programming of the stimulation parameters. The chapter also examines the antiepileptic efficacy of stimulation in all the known targets including vagus nerve, cerebellum, thalamus, subthalamic nucleus, locus ceruleus, and epileptogenic cortex. On the basis of the current evidence, the future directions of this exciting field are described.