Deep Brain Stimulation: Treating the Most Complex Epilepsy Cases

Introduction

Epilepsy can range from people who you would never know they had seizures to those who just drop. There are various types of seizures, including partial simple seizures and partial complex seizures, which depend on the brain's areas from which the seizures originate. These can present in many different ways and can be quite disruptive to one's life, especially for those who continue to take medication without success.

For patients who have tried multiple medications—sometimes as many as five or six—without stopping their seizures, a neurosurgical workup becomes necessary. The goal is to identify if surgery can fix the problem or if other treatments are needed. However, only about 20% of these patients are candidates for resective surgery, which involves removing the seizure-causing area without damaging the rest of the brain. When seizures come from multiple locations or areas that cannot be resected, deep brain stimulation (DBS) becomes an exciting alternative.

Neuromodulation through DBS is critical for these patients. It involves placing electrodes in a central hub of the brain known as the thalamus, specifically in a nucleus within the thalamus. The continuous stimulation from these electrodes helps to modulate the networks that seizures spread through, effectively quieting or stopping the seizures. This offers a way to control otherwise uncontrollable seizures without removing brain parts.

The Yale Epilepsy Program has a half-century-long history of a highly collaborative, research-intensive approach to epilepsy treatment, making it a prime place for handling complicated cases. The program focuses on finding the least invasive methods to stop seizures while continuously advancing scientific and clinical research in the field. This is an exciting time in epilepsy: almost everyone with medication-refractory epilepsy now has a treatment option, thanks to the ongoing development of more targeted therapies.

Keywords

• Epilepsy
• Seizures
• Deep Brain Stimulation (DBS)
• Neuromodulation
• Thalamus
• Resective Surgery
• Neurosurgical Workup
• Yale Epilepsy Program
• Medication-Refractory Epilepsy
• Seizure Networks

FAQ

Q: What are the types of seizures?
A: Seizures can be partial simple, partial complex, or other variations depending on which part of the brain they originate from.

Q: What happens if medications don't work for epilepsy?
A: If medications fail, a neurosurgical workup is required to determine if surgery can resolve the issue or if other treatments like deep brain stimulation (DBS) are needed.

Q: What makes a person a candidate for resective surgery?
A: Only about 20% of patients are candidates, depending on whether the seizure-causing area can be removed without damaging crucial parts of the brain.

Q: What is Deep Brain Stimulation (DBS)?
A: DBS involves placing electrodes in the thalamus to modulate and control the spread of seizure networks, effectively reducing or stopping seizures.

Q: Why is the Yale Epilepsy Program notable?
A: Yale's program has a long history of collaborative, research-intensive approaches, handling complex cases and continuously advancing epilepsy treatment options.