Focus on desynchronization rather than excitability: A new strategy for intraencephalic electrical stimulation

• Published in: Epilepsy & behavior 2014-09, Vol.38, p.32-36
• Main Authors: Medeiros, Daniel de Castro, Moraes, Márcio Flávio Dutra
• Format: Article
• Language: English
• Subjects: DBS; Deep Brain Stimulation - methods; Electrophysiological Phenomena - physiology; Epilepsy; Epilepsy - physiopathology; Epilepsy - therapy; Excitability; Humans; Neurology; Synchronization; Temporally coded
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2013.12.034

Abstract Epilepsy is a severely debilitating brain disease, often associated with premature death, which has an urgent need for alternative methods of treatment. In fact, roughly 25% of patients with epilepsy do not have seizures satisfactorily controlled by pharmacological treatment, and 30% of these patients with treatment-refractory seizures are not even eligible for ablative surgery. Epilepsy is most readily identifiable by its seizures and/or paroxysmal events, mostly viewed as spontaneously recurrent and unpredictable, which are caused by stereotyped changes in neurological function associated with hyperexcitability and hypersynchronicity of the underlying neural networks. Treatment has strongly been based on the fixed goal of depressing neuronal activity, working under the veiled assumption that hyperexcitability would lead to synchronous neuronal activity and, therefore, to seizure. Over the last 20–30 years, the emergence of electrical (ES) of deep brain structures, a practicable option for treating patients with otherwise untreatable seizures, has broadened our understanding of anticonvulsant mechanisms that conceptually differ from those of pharmacological treatment. Conversely, the research on ES therapy applied to epilepsy is contributing significantly to untwine the phenomena of excitation from that of synchronization as potential target mechanisms for abolishing seizures and predicting paroxysmal events. This paper is, thus, an addendum to other reviews on the subject of ES therapy in epilepsy which focuses on the desynchronization effect ES has on epileptogenic neural networks rather than its effect on overall brain excitability. This article is part of a Special Issue entitled “NEWroscience 2013”.