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Technology Insight: neuroengineering and epilepsy—designing devices for seizure control

Nature Clinical Practice Neurology volume 4, pages 190–201 (2008)Cite this article

Abstract

Despite substantial innovations in antiepileptic drug therapy over the past 15 years, the proportion of patients with uncontrolled epilepsy has not changed, highlighting the need for new treatment strategies. New implantable antiepileptic devices, which are currently under development and in pivotal clinical trials, hold great promise for improving the quality of life of millions of people with epileptic seizures worldwide. A broad range of strategies to stop seizures is currently being investigated, with various modes of control and intervention. The success of novel antiepileptic devices rests upon collaboration between neuroengineers, physicians and industry to adapt new technologies for clinical use. The initial results with these technologies are exciting, but considerable development and controlled clinical trials will be required before these treatments earn a place in our standard of clinical care.

Key Points

  • Up to 25% of the 50 million people with epilepsy worldwide are unable to control their seizures with currently available medications

  • Implantable devices are being developed to help control seizures in patients with medically refractory epilepsy

  • Open-loop electrical stimulation devices, which lack intrinsic feedback control, are currently being used to treat medically refractory epilepsy

  • A closed-loop device with real-time surface and depth electroencephalographic monitoring is currently in clinical trial; second-generation closed-loop devices will use earlier seizure markers as feedback

  • Other antiseizure devices currently in development use techniques such as drug delivery, focal cooling and magnetic stimulation

  • Future research must address the issues of how to define a seizure, what causes a seizure, and how a seizure can be stopped

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Figure 1: The Vagus Nerve Stimulator, manufactured by Cyberonics.
Figure 2: The Medtronic Kinetra® device (Minneapolis, MN).
Figure 3: The NeuroPace Responsive Neurostimulator (RNS®) System (Mountain View, CA).

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Authors and Affiliations

  1. WC Stacey is a Postdoctoral Fellow and B Litt is an Associate Professor in the Departments of Epilepsy and Bioengineering, University of Pennsylvania, Philadelphia, PA, USA.,

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  1. William C Stacey
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Correspondence to William C Stacey.

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Competing interests

B Litt is a stockholder and patent holder with NeuroPace, and a consultant for NeuroVista. WC Stacey declared no competing interests.

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Stacey, W., Litt, B. Technology Insight: neuroengineering and epilepsy—designing devices for seizure control. Nat Rev Neurol 4, 190–201 (2008). https://doi.org/10.1038/ncpneuro0750

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