Abstracts

Summary: Brain stimulation has been proposed as effective treatment for epilepsy. The workshop will discuss the proposed mechanisms and most effective mode of brain stimulation in humans and animals. Dr Jobst will present an overview of the two types of stimulation that are currently investigated in humans: Non-responsive intermittent or continuous stimulation of the hippocampus or the thalamus and responsive stimulation of cortical structures or the hippocampus. Non-responsive stimulation delivers an electrical stimulus at a constant rate regardless of ongoing seizure activity. Responsive stimulation is intended to abort emerging electrical seizures. Large scale clinical investigations are currently underway to assess the efficacy of those stimulation schemes in humans. Results of those studies are still pending, but procedure and variability of stimulation parameters are under discussion. The most optimal stimulation paradigm is yet to be determined. There have been some animal studies assessing the efficacy of brain stimulation for epilepsy, however human studies seem to precede animal data. It is the scope of this workshop to combine human and animal experience regarding mechanisms, procedure and efficacy of brain stimulation for epilepsy. Dr Velasco will discuss efficacy and safety of non-responsive intracranial electrical stimulation for seizure control. He will share human experience and details about thalamic, hippocampal, cortical cerebral and cerebellar stimulation. Dr Boon will share the experience at his center in animals and humans supporting continuous hippocampal stimulation. Dr Lado will speak about efficacy of stimulation of the subthalamic or anterior nucleus of the thalamus in rodents. He performed stimulation studies in both structures and observed that deep brain stimulation in subthalamic nucleus was acutely anticonvulsant while stimulation of the anterior thalamic nucleus was proconvulsant. Choosing the right animal model is crucial to predict results in humans. There is evidence that stimulation activates the target rather than creating a "reversible lesion". Dr. Mogul will present his work using seizure dynamics with proportional feedback stimulation in rodents. Pierre-Pascal Lenk-Santini, PhD and Robert Fischer, MD will serve as discussants.