Abstract
The introduction of neuromodulation was a revolutionary advancement in the antiseizure
armamentarium for refractory epilepsy. The basic principle of neuromodulation is to
deliver an electrical stimulation to the desired neuronal site to modify the neuronal
functions not only at the site of delivery but also at distant sites by complex neuronal
processes like disrupting the neuronal circuitry and amplifying the functions of marginally
functional neurons. The modality is considered open-loop when electrical stimulation
is provided at a set time interval or closed-loop when delivered in response to an
incipient seizure. Neuromodulation in individuals older than 18 years with epilepsy
has proven efficacious and safe. The use of neuromodulation is extended off-label
to pediatric patients with epilepsy and the results are promising. Vagus nerve stimulation
(VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) are Food
and Drug Administration-approved therapeutic techniques. The VNS provides retrograde
signaling to the central nervous system, whereas DBS and RNS are more target specific
in the central nervous system. While DBS is open-loop and approved for stimulation
of the anterior nucleus of the thalamus, the RNS is closed-loop and can stimulate
any cortical or subcortical structure. We will review different modalities and their
clinical efficacy in individuals with epilepsy, with a focus on pediatric patients.
Keywords
neuromodulation - VNS - RNS - DBS - drug-resistant epilepsy
