Update of neurositmulation for refractory epilepsy: Deep brain stimulation and responsive neurostimulation

Over the past decade, rapid advances in the application of neurostimulation to refractory epilepsy have taken place. Alongside conventional extracranial stimulation such as vagus nerve stimulation, intracranial neurostimulation is becoming the mainstream of treatment. Regarding treatment response, large-scale randomized controlled studies with long-term follow-up have revealed that anterior thalamic nucleus deep brain stimulation (ATN-DBS) and responsive neurostimulation (RNS) can both achieve nearly 50% reductions in seizure frequency for specific types of refractory epilepsy. As for safety, compared to general epilepsy patients, no significant increase in depression, status epilepticus, suicide, or sudden death were noted. Here we discuss the evolution of these two types of intracranial stimulation, summarize the latest research results, and conclude with a review of currently unresolved issues. ? 2016, Neurological Society R.O.C (Taiwan). All rights reserved.