Brain stimulation is an evolving treatment for medically refractory epilepsy. This session will convey the basic anti-seizure mechanisms of brain stimulation. The history of brain stimulation will be presented as well as a discussion of the sites of stimulation in animal models. How electrical current spreads through brain tissue will be explained. Conceptualization of brain stimulation paradigms as ablative forces will be discussed, and information on how stimulation of a network can modulate an epileptogenic focus will be addressed. Examples of how chronic stimulation can modulate protein pathways and lead to neuroplastic changes will be presented; potential mechanisms of improved efficacy over time will be covered. Clinical studies have sometimes proceeded with only limited understanding of the basic mechanisms. As competing and complementary technologies emerge, new treatment algorithms should be developed to direct patients to the best treatment options. Understanding of the neurobiology and mechanisms of brain stimulation may illuminate clinical trials and treatment decisions, contributing to the development of anti-seizure therapeutic best practices utilizing this approach.
Following participation in this session, learners should be able to:
- Discuss the anti-seizure mechanisms of brain stimulation for medically refractory epilepsy.
- Provide an overview of empirical observations of various sites of anti-seizure stimulation.
- Describe how anti-seizure stimulation can both disrupt and drive local neuronal circuits.
- Delineate the network effects of anti-seizure stimulation.
- List chronic the neuronal changes that may drive long term benefits of brain stimulation for epilepsy.
Intermediate and Advanced
Chair: Kevin Graber, M.D.
Introduction and Overview of Brain Stimulation in Models and Patients: Targets and Empirical Effects
Kevin Graber, M.D.
Mechanisms of Seizure Control with Local Circuit Stimulation
Dominique Durand, Ph.D.
Modulation of Epileptic Networks with Electrical Stimulation
Kristl Vonck, M.D., Ph.D.
Positive Cascades: Improving Efficacy and Outcomes
Esther Krook-Magnuson, Ph.D.
Kevin Graber, M.D.
Attendees of the 2016 Annual Meeting have free access to recordings.