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Neurotherapeutics

, Volume 16, Issue 1, pp 119–127 | Cite as

Closed-Loop Brain Stimulation for Drug-Resistant Epilepsy: Towards an Evidence-Based Approach to Personalized Medicine

  • Nathaniel D. SistersonEmail author
  • Thomas A. Wozny
  • Vasileios Kokkinos
  • Alexander Constantino
  • R. Mark Richardson
Review
  • 237 Downloads

Abstract

Closed-loop brain stimulation is one of the few treatments available for patients who are ineligible for traditional surgical resection of the epileptogenic zone, due to having generalized epilepsy, multifocal epilepsy, or focal epilepsy localized to an eloquent brain region. Due to its clinical efficacy and potential to delivery personalized therapy based on an individual’s own intracerebral electrophysiology, this treatment is becoming an important part of clinical practice, despite a limited understanding of how to program detection and stimulation parameters for optimal, patient-specific benefit. To bring this challenge into focus, we review the evolution of neural stimulation for epilepsy, provide a technical overview of the RNS System (the only FDA-approved closed-loop device), and discuss the major challenges of working with a closed-loop device. We then propose an evidence-based solution for individualizing therapy that is driven by a bottom-up informatics approach.

Key Words

closed-loop neuromodulation seizure detection device configuration neural stimulation drug-resistant epilepsy 

Notes

Acknowledgments

This work was partially funded by the Walter L. Copeland Fund of the Pittsburgh Foundation. NDS and TAW were trainees in the Physician Scientist Training Program (PSTP) at the University of Pittsburgh School of Medicine. The authors thank NeuroPace, Inc., for the assistance with data transfers and for clarifying ambiguities in RNS System documentation.

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Supplementary material

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Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2018

Authors and Affiliations

  1. 1.Brain Modulation Lab, Department of Neurological SurgeryUniversity of PittsburghPittsburghUSA
  2. 2.University of Pittsburgh Comprehensive Epilepsy CenterPittsburghUSA

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