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Brain stimulation can control epilepsy. What else can it do?

A light bulb rests illuminated on an open book. Ashesh Mehta, MD, discusses his work mapping the brain and its potential to treat diseases like epilepsy

As vagus nerve and deep brain stimulation have reduced seizures and lead to better controlled epilepsy, researchers are mapping the brain to learn its possibilities

For years, people have relied on anti-seizure medications to keep epilepsy at bay. But what happens when medication doesn’t work?

This is a stark reality for about 35 percent of people suffering from the neurological disorder. For many, traditional surgery involving removing a brain area that causes seizures may not be possible.

Recent advancements have uncovered new treatments for people who continue to have seizures despite antiepileptic medications. Deep brain stimulation is a proven solution for Parkinson’s, essential tremor and now epilepsy.

Brain stimulation and vagus nerve stimulators have recently changed how treatment is delivered, yielding highly encouraging results. Clinicians using stimulation can record and vividly see which areas of the brain are becoming activated in ways that were unthinkable a mere few years ago. And we continue to map the brain to identify what areas we can stimulate to treat illness.

Controlling epilepsy

Finding the right medication or combination of drugs can be challenging because each patient has unique circumstances with respect to brain area of seizure onset, as well as frequency and type of seizures. Surgery is often only for those who have seizures in a very focused part of the brain.

Stimulation options include:

  • Vagus-nerve stimulation: Much like a pacemaker for the heart, a device is implanted under the skin of your chest. Small wires from this device are wrapped around the vagus nerve in the neck. The device uses the nerve to send signals to the brain. This method has reduced seizures by 20-40 percent for patients living in the US. Investigators at Northwell Health’s Feinstein Institute for Medical Research have already used vagus nerve stimulation to reduce seizures in hundreds of epilepsy patients. The Feinstein Institute has also participated in a clinical trial for vagus nerve stimulators to treat lupus, rheumatoid arthritis and other conditions.
  • Responsive neurostimulation (RNS): This is a device implanted into the brain that both records epileptic activity in the brain from seizure-producing areas in the brain and electrically stimulates those brain areas to stop a seizure in its tracks. The device is usually implanted into the outermost part of the brain called the cerebral cortex and provides the added benefit of detecting seizure activity in addition to being able to stop it. While seizure-reduction appear to be better than with vagus nerve stimulation, to be a candidate for this surgery, one must have seizures coming from one or two areas of the brain and these areas must be precisely identified.
  • Deep brain stimulation (DBS): After obtaining promising results from a clinical trial, one year ago, the FDA approved DBS therapy as an adjunctive treatment for reducing seizures. The procedure implants electrodes into a deeper area of the brain called the thalamus, which connects to a large number of areas in the brain that may produce seizures. Seizure outcomes are similar to RNS and better than VNS. Unlike the RNS, DBS does not record seizures. However, DBS may be used in patients who have seizures coming from multiple brain areas, and it is not necessary to pinpoint the seizure-producing areas in the brain. While FDA-approved for tremors, Parkinson’s Disease, obsessive-compulsive disorder and now epilepsy, studies using DBS to remedy Tourette syndrome, Alzheimer’s disease, depression, chronic pain, trigeminal neuralgia and multiple sclerosis are currently being reviewed by the FDA.

On the horizon

As technology accelerates, so does our knowledge of the brain. Consider that facial recognition wasn’t available 20 years ago. Now, computers can recognize thousands of faces instantly, delivering unparalleled identification.

Brain stimulation is on a similar trajectory. But we are still developing the Rosetta Stone for truly understanding the brain and how to activate it.

At the Feinstein Institute, we are learning what harnesses excitability and building a large database to detail the targets and responses in hopes to eventually find treatments for numerous conditions through bioelectronic medicine, an emerging field that combines neuroscience, molecular medicine and bioengineering to tap into the nervous system to treat disease and injury without the use of pharmaceuticals.

Many available stimulators work by silencing areas of the brain. We need to build devices that ignite the brain.

Smart stimulation devices, such as RNS, are a significant improvement from the older open-loop instruments in that they automatically stimulate the brain and work in much more natural ways — helping the brain communicate with itself and activate the device when an issue arises.

Brain stimulation is a neuro-enhancement and has changed the game for those with epilepsy. These devices now have potential to be a solution for a wide range of neurological, psychiatric and cognitive disorders, too.

The possibilities are endless.

Ashesh Mehta, MD, PhD, is director of neurosurgical epilepsy at Northwell Health’s Institute for Neurology and Neurosurgery. He is also an associate professor at The Feinstein Institute for Medical Research’s Institute of Bioelectronic Medicine and director of the Laboratory for Human Brain Mapping.