Epilepsy, a widespread neurological disorder, profoundly disrupts daily activities and diminishes quality of life (QoL), particularly in those afflicted with drug-resistant epilepsy (DRE). The pathophysiology of epilepsy, marked by recurrent seizures stemming from neural circuit dysregulation, neuroinflammation, and genetic predispositions, precipitates cognitive, physical, and social impairments. Neuromodulation techniques, such as Vagus Nerve Stimulation (VNS), Responsive Neurostimulation (RNS), and Deep Brain Stimulation (DBS), are therapeutic avenues by modulating neural circuits to attenuate seizure activity. VNS entails the electrical stimulation of the vagus nerve, resulting in enhanced seizure control and improved disability outcomes. RNS administers targeted electrical stimulation in response to detected seizure activity, thereby augmenting daily functionality. DBS focuses on brain regions including the anterior nucleus of the thalamus, centromedian nucleus, pulvinar nucleus, and hippocampus, effectively reducing seizure burden and ameliorating disability outcomes. Stereo-Electroencephalography serves as an indispensable diagnostic modality for precisely mapping epileptogenic zones, thereby informing surgical strategies. Interventions such as resective surgeries, thermocoagulation, and laser ablation effectively mitigate DRE by interrupting the generation and propagation of seizures. Laser interstitial thermal therapy (LITT), a minimally invasive procedure, offers the advantages of diminished surgical risk, abbreviated hospitalization, and favorable seizure control outcomes. Additionally, surgical techniques like corpus callosotomy, multiple subpial transections, hemispherectomy, and stereotactic radiosurgery are employed to manage DRE in carefully selected cases. Persistent surveillance and enduring management, encompassing routine follow-up evaluations, are imperative for sustained amelioration of disabilities. An integrative, patient-centric methodology guarantees optimal results. Progressions in neuroimaging, genetic profiling, computational modeling, robotic-assisted surgery, and nascent technologies such as high-intensity focused ultrasound and LITT further augment neuromodulation and surgical interventions. These innovations herald comprehensive and efficacious management of DRE, ultimately elevating the QoL for affected individuals. This entry meticulously explores the efficacy of neuromodulation and surgical interventions in mitigating the disabilities concomitant with DRE.

Neuromodulation and Surgery for Drug-Resistant Epilepsy

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发表日期：

2025年

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Baraa Dabboucy,
Paule Lessard Bonaventure

摘要

Epilepsy, a widespread neurological disorder, profoundly disrupts daily activities and diminishes quality of life (QoL), particularly in those afflicted with drug-resistant epilepsy (DRE). The pathophysiology of epilepsy, marked by recurrent seizures stemming from neural circuit dysregulation, neuroinflammation, and genetic predispositions, precipitates cognitive, physical, and social impairments. Neuromodulation techniques, such as Vagus Nerve Stimulation (VNS), Responsive Neurostimulation (RNS), and Deep Brain Stimulation (DBS), are therapeutic avenues by modulating neural circuits to attenuate seizure activity. VNS entails the electrical stimulation of the vagus nerve, resulting in enhanced seizure control and improved disability outcomes. RNS administers targeted electrical stimulation in response to detected seizure activity, thereby augmenting daily functionality. DBS focuses on brain regions including the anterior nucleus of the thalamus, centromedian nucleus, pulvinar nucleus, and hippocampus, effectively reducing seizure burden and ameliorating disability outcomes. Stereo-Electroencephalography serves as an indispensable diagnostic modality for precisely mapping epileptogenic zones, thereby informing surgical strategies. Interventions such as resective surgeries, thermocoagulation, and laser ablation effectively mitigate DRE by interrupting the generation and propagation of seizures. Laser interstitial thermal therapy (LITT), a minimally invasive procedure, offers the advantages of diminished surgical risk, abbreviated hospitalization, and favorable seizure control outcomes. Additionally, surgical techniques like corpus callosotomy, multiple subpial transections, hemispherectomy, and stereotactic radiosurgery are employed to manage DRE in carefully selected cases. Persistent surveillance and enduring management, encompassing routine follow-up evaluations, are imperative for sustained amelioration of disabilities. An integrative, patient-centric methodology guarantees optimal results. Progressions in neuroimaging, genetic profiling, computational modeling, robotic-assisted surgery, and nascent technologies such as high-intensity focused ultrasound and LITT further augment neuromodulation and surgical interventions. These innovations herald comprehensive and efficacious management of DRE, ultimately elevating the QoL for affected individuals. This entry meticulously explores the efficacy of neuromodulation and surgical interventions in mitigating the disabilities concomitant with DRE.