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Brain stimulation and epilepsy: electrical stimulus characteristics
Published in Hans O Lüders, Deep Brain Stimulation and Epilepsy, 2020
Neurostimulation can be thought of as being a tool for treating neurological dysfunction. The particular therapeutic application will determine which part of the nervous system is activated or deactivated by stimulation. There are basic principles associated with the use of neurostimulation which aid the clinician in predicting the effects of using different stimulation parameters in a safe manner with the desired outcome.
From assessment to intervention
Published in Rosa Angela Fabio, Tindara Caprì, Gabriella Martino, Understanding Rett Syndrome, 2019
Rosa Angela Fabio, Tindara Caprì, Gabriella Martino
The neurostimulation techniques can influence specific parts of the brain by activation or inhibition of their functionality. Many neurological and psychiatric disorders are correlated to a hyperfunction or hypofunction of specific areas of the nervous system; neurostimulation methods represent a therapeutic possibility which is based on the principle of the normalization of the activity in the dysfunctional areas. Hence, we talk about “neuromodulation” i.e. the application of neurostimulation techniques with the aim to reactivate the normal activity or function of specific dysfunctional areas or structures of the brain.
The Dynamic Gracilis Procedure
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
C. G. M. I. Baeten, J. Konsten
Chronic stimulation of the gracilis gives a change in muscle composition and the muscle is able to sustain a constant high tonus for a long time. When this stimulation is given by a totally implanted neurostimulator the problem of voluntary contraction is overcome. The patient no longer needs to think about contracting his gracilis because the stimulator will provide continuous stimuli.
Current and future pharmacotherapy options for drug-resistant epilepsy
Published in Expert Opinion on Pharmacotherapy, 2022
Are any of these drugs going to change the treatment of epilepsy? This is difficult to tell. ASMs still represent the main treatment for epilepsy, but they are not the only option. Surgical techniques are advancing as well as research into neurostimulation. This will reinforce the need to identify good outcome measures. In terms of seizure-based outcomes, the definition of drug-resistance proposed by the ILAE introduced a few important points such as the duration of the observation and the relapsing remitting nature of some epilepsy syndromes. It goes without saying that the short follow-up provided by regulatory trials is insufficient to gain any information on the usefulness of specific compounds in the long term. In this regard, phase IV trials will be needed but will need to adopt the same criteria in terms of seizure freedom and comparable outcome measures. In addition to seizure-based outcomes, it is important to recognize that that several factors beyond seizure frequency are relevant for patients with drug-resistant epilepsy and these include comorbidities, especially cognitive and psychiatric ones. Potentially, this could lead to the development of new compounds targeting specific comorbidities in addition to seizures, but none of the drugs currently under development appear to address this issue.
Can we use the dynamic and complex interplay between pain and sleep to quantify neuromodulation responsiveness for chronic pain?
Published in Expert Review of Neurotherapeutics, 2021
Thomas Kinfe, Michael Buchfelder, Andreas Stadlbauer
To date, robustly designed (randomized-controlled) human studies are increasingly evaluating noninvasive and invasive neurostimulation therapies (e.g. deep brain stimulation, motor cortex stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, transcranial alternating stimulation, cervical noninvasive vagus nerve stimulation, different spinal cord stimulation waveforms and dorsal root ganglion stimulation) for refractory chronic pain disorders, such as primary headache disorders, lower back pain, neuropathic leg pain and complex regional pain syndrome [7–13]. These studies have underscored the usefulness of neurostimulation as an adjunctive treatment strategy for use with pharmacological-behavioral therapies. However, none of these studies have incorporated objective sleep measures, such as polysomnography, actinography, electromyography or electroencephalography [7–13].
Neuromodulation - Science and Practice in Epilepsy: Vagus Nerve Stimulation, Thalamic Deep Brain Stimulation, and Responsive NeuroStimulation
Published in Expert Review of Neurotherapeutics, 2019
Matthew S. Markert, Robert S. Fisher
Neurostimulation, or more accurately neuromodulation, is a relatively new therapy in the management of neurologic disease, although the concept of using electricity to treat brain diseases dates to antiquity [1]. The Roman Scribonius Largus (c.e. 1–50), physician to Emperors Tiberius and Claudius, described use of the electric ray torpedo occidentalis for curing pain from gout, and to arrest intractable headaches by placement against the skin[2]. Detailed use of fish bioelectrogenesis by physicians as an effective treatment for headaches, and possibly epilepsy, was described by the Persian author Ibn Sina in 1025 [3]. Vagus nerve stimulation (VNS) was approved in Europe in 1994 and in the United States in 1997, thalamic deep brain stimulation (DBS) for epilepsy in Europe in 2010 and the United States in 2018, and responsive neurostimulation (RNS) was approved in the United States in 2013. Several comparative and systematic reviews among these devices have been previously reported [4–11], but few focus discussion on the science underlying device use. No reviews have come out since approval of DBS in the United States, or discuss very recent documentation of the beneficial impact of neuromodulation in reducing risk for sudden unexpected death in epilepsy (SUDEP).