TY - JOUR
T1 - Toward rational design of electrical stimulation strategies for epilepsy control
AU - Sunderam, Sridhar
AU - Gluckman, Bruce
AU - Reato, Davide
AU - Bikson, Marom
N1 - Funding Information:
The writing of this article was supported in part by NIH , (grants R01EB001507, R01NS065096, R03NS065451), The Pennsylvania Keystone Innovation Program, The Pennsylvania Tobacco Settlement, The Andy Grove Foundation , and The Epilepsy Foundation . The authors are grateful to Ivan Osorio, M.D., William Stacey, M.D., and Steve L. Weinstein, M.D. for their helpful and insightful comments.
PY - 2010/1
Y1 - 2010/1
N2 - Electrical stimulation is emerging as a viable alternative for patients with epilepsy whose seizures are not alleviated by drugs or surgery. Its attractions are temporal and spatial specificity of action, flexibility of waveform parameters and timing, and the perception that its effects are reversible unlike resective surgery. However, despite significant advances in our understanding of mechanisms of neural electrical stimulation, clinical electrotherapy for seizures relies heavily on empirical tuning of parameters and protocols. We highlight concurrent treatment goals with potentially conflicting design constraints that must be resolved when formulating rational strategies for epilepsy electrotherapy, namely, seizure reduction versus cognitive impairment, stimulation efficacy versus tissue safety, and mechanistic insight versus clinical pragmatism. First, treatment markers, objectives, and metrics relevant to electrical stimulation for epilepsy are discussed from a clinical perspective. Then the experimental perspective is presented, with the biophysical mechanisms and modalities of open-loop electrical stimulation, and the potential benefits of closed-loop control for epilepsy.
AB - Electrical stimulation is emerging as a viable alternative for patients with epilepsy whose seizures are not alleviated by drugs or surgery. Its attractions are temporal and spatial specificity of action, flexibility of waveform parameters and timing, and the perception that its effects are reversible unlike resective surgery. However, despite significant advances in our understanding of mechanisms of neural electrical stimulation, clinical electrotherapy for seizures relies heavily on empirical tuning of parameters and protocols. We highlight concurrent treatment goals with potentially conflicting design constraints that must be resolved when formulating rational strategies for epilepsy electrotherapy, namely, seizure reduction versus cognitive impairment, stimulation efficacy versus tissue safety, and mechanistic insight versus clinical pragmatism. First, treatment markers, objectives, and metrics relevant to electrical stimulation for epilepsy are discussed from a clinical perspective. Then the experimental perspective is presented, with the biophysical mechanisms and modalities of open-loop electrical stimulation, and the potential benefits of closed-loop control for epilepsy.
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U2 - 10.1016/j.yebeh.2009.10.017
DO - 10.1016/j.yebeh.2009.10.017
M3 - Review article
C2 - 19926525
AN - SCOPUS:72949084170
SN - 1525-5050
VL - 17
SP - 6
EP - 22
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
IS - 1
ER -