Meta-analyses of high quality research trials show that the VNS Therapy System (Liva Nova, plc.) is safe and reduced seizures by half or more over 2 years in most patients with epilepsy that is refractory to medical therapy alone.
Moderate quality studies reporting consistent findings show that the Neuropace RNS Systems (Neuropace, Inc.) effectively reduces epileptic seizure frequency within three months and up to nine years.
Moderate quality research studies demonstrate that various deep brain stimulation devices reduce seizure frequency as much as five fold. Patients also reported improvements in quality of life, such as a decrease in anxiety and depression.
These implantable systems are intended for patients with seizures not sufficiently controlled by medication, and as an alternative to surgery designed to destroy brain tissue responsible for the seizures.
If you are suffering from persistent seizures despite being on Anti-epileptic drugs (AEDs), we highly suggest you seek out a qualified provider who specializes in these treatment modalities to discuss whether you would benefit from any of these technologies.
Epilepsy is a neurological disorder characterized by unpredictable recurrent seizures. It affects people of all ages, but is most commonly diagnosed in children and young adults. There is no cure for epilepsy, but there are a number of treatment options available that can help to control seizures and improve quality of life. Epilepsy can be a challenging condition to live with, but there are a number of treatment options for people to manage their condition and live a full and productive life.
Lifestyle Modifications
While the most common treatment for epilepsy is with medications, certain Lifestyle changes can help people with epilepsy manage their condition. Such interventions include:
Dietary therapies:
There are a number of dietary therapies that have been shown to be helpful in controlling seizures in some people with epilepsy. These include the ketogenic diet, the modified Atkins diet, and the low glycemic index diet.
Getting enough sleep
Sleep deprivation is a common trigger for seizures. Getting enough sleep can help to reduce the risk of seizures.
Avoiding alcohol and drugs
Alcohol and drugs can lower the seizure threshold, making it more likely for someone to have a seizure.
Avoiding triggers
If you know what triggers your seizures, try to avoid those triggers. Common triggers include flashing lights, stress, and lack of sleep.
Taking medication on time
It is important to take your medication on time, even if you are feeling well. Missing doses of medication can increase the risk of seizures.
Wearing a medical alert bracelet or necklace
This will let people know that you have epilepsy and what to do if you have a seizure.
Medication Management
The most common treatment for epilepsy is medication. Anti-epileptic drugs (AEDs) work by changing the levels of chemicals in the brain that are thought to be involved in seizures. AEDs can be effective in controlling seizures in about 70% of people with epilepsy. However, it is important to note that many patients may suffer from debilitating side effects. Also, it may take quite some time and experimentation to find the right medication and dosage schedule.
There are many different medications that can be used to treat epilepsy. The type of medication that is best for you will depend on the type of seizures you have, your age, your overall health, and other factors.
Some of the most common medications used to treat epilepsy include:
- Carbamazepine (Tegretol, Carbatrol): Carbamazepine is a type of anticonvulsant medication that is used to treat partial seizures and tonic-clonic seizures. It can also be used to treat trigeminal neuralgia.
- Lamotrigine (Lamictal): Lamotrigine is a type of anticonvulsant medication that is used to treat partial seizures and tonic-clonic seizures. It can also be used to treat bipolar disorder.
- Levetiracetam (Keppra): Levetiracetam is a type of anticonvulsant medication that is used to treat partial seizures and tonic-clonic seizures. It can also be used to treat myoclonic seizures.
- Oxcarbazepine (Trileptal): Oxcarbazepine is a type of anticonvulsant medication that is used to treat partial seizures and tonic-clonic seizures. It can also be used to treat trigeminal neuralgia.
- Phenytoin (Dilantin): Phenytoin is a type of anticonvulsant medication that is used to treat partial seizures and tonic-clonic seizures. It can also be used to treat status epilepticus.
- Topiramate (Topamax): Topiramate is a type of anticonvulsant medication that is used to treat partial seizures and tonic-clonic seizures. It can also be used to treat migraine headaches.
- Valproic acid (Depakote, Depakene): Valproic acid is a type of anticonvulsant medication that is used to treat partial seizures and tonic-clonic seizures. It can also be used to treat bipolar disorder and migraine headaches.
As mentioned, anticonvulsant medications can have side effects, so it is important to talk to your doctor about the risks and benefits of these medications. Some of the most common side effects of anticonvulsant medications include:
- Drowsiness
- Dizziness
- Double vision
- Nausea
- Vomiting
- Headache
- Weight gain
- Hair loss
- Skin rash
- Liver damage
- Bone marrow suppression
If you experience any of these side effects, it is important to talk to your doctor. Your doctor may need to adjust your dosage or change your medication.
If AEDs are not effective in controlling seizures, other treatment options may be considered.
Surgery to Remove or Modify Selected Brain Tissue
Surgery may be an option for people with epilepsy who have seizures that are not controlled by medication or who have other medical problems that make them at risk for seizures. Surgery can be used to remove the part of the brain that is causing the seizures. There are a number of surgical procedures that can be used to treat epilepsy. The type of surgery that is best for you will depend on the location of the seizures in your brain, the severity of your epilepsy, and your overall health.
Focal resection
This is the most common type of epilepsy surgery. It involves removing the part of the brain that is causing the seizures. This surgery is usually done for people who have seizures that are not controlled by medication and who have a clear focus of the seizures in their brain.
Corpus callosotomy
This surgery involves cutting the corpus callosum, which is a bundle of nerves that connects the two sides of the brain. This surgery is usually done for people who have seizures that spread from one side of the brain to the other.
Stereotactic radiosurgery
This surgery uses high-energy beams of radiation to destroy the part of the brain that is causing the seizures. This surgery is usually done for people who have seizures that are not controlled by medication and who have a clear focus of the seizures in their brain.
Surgical treatment for epilepsy is not without risks. Some of the risks associated with surgery include infection, bleeding, and damage to healthy brain tissue. However, for many people with epilepsy, the benefits of surgery outweigh the risks.
Implantable Medical Devices
Highly sophisticated miniature computerized medical devices can be implanted in the body in a minimally invasive manner without removing, destroying, or modifying brain tissue. They deliver electrical micro currents to the brain or other parts of the body to enhance the body’s natural mechanisms for suppressing seizures.
There are three types of implantable medical devices approved to treat epilepsy: vagus nerve stimulators (VNS), responsive neurostimulators (RNS), and deep brain stimulators (DBS).
- VNS devices are implanted in the chest and send electrical signals to the vagus nerve, which runs from the brain to the chest. The vagus nerve is involved in controlling seizures. VNS devices are approved for the treatment of partial-onset seizures that have not been controlled with medication. VNS devices are the most commonly implanted medical device for epilepsy. They are relatively easy to implant and have a low risk of serious side effects.
- RNS devices are implanted under the skin in your scalp and have electrodes that are placed on the surface of your brain to monitor brain activity. When the device detects a seizure, it sends electrical signals to the brain to stop the seizure from happening. RNS devices are approved for the treatment of partial-onset seizures that have not been controlled with medication. RNS devices are more effective than VNS devices in reducing the frequency of seizures. However, RNS devices are more complex to implant and have a higher risk of serious side effects.
- DBS is a surgical procedure that involves implanting electrodes in specific areas of the brain to deliver electrical stimulation. DBS is used to treat a variety of neurological disorders, including Parkinson’s disease, essential tremor, and dystonia. DBS has also been shown to be an effective treatment for epilepsy. In DBS for epilepsy, the electrodes are implanted in areas of the brain that are involved in the generation of seizures. The electrical stimulation from the electrodes helps to suppress the abnormal electrical activity that causes seizures. DBS is not a cure for epilepsy, but it can be an effective treatment for people who have not responded to other treatments, such as medication or surgery. DBS can help to reduce the frequency and severity of seizures, and it can improve quality of life.
All three types of implantable medical devices have been shown to be effective in reducing the frequency and severity of seizures. However, there are some differences between the devices.
Here is a table summarizing the key differences between the three types of implantable medical devices:
| Device | Location of Implant | Mechanism of Action | Effectiveness |
|---|---|---|---|
| VNS | Chest | Sends electrical signals to the vagus nerve | Effective in reducing the frequency of seizures |
| RNS | Skull | Monitors brain activity and sends electrical signals to the brain to stop seizures | More effective than VNS devices in reducing the frequency of seizures |
| DBS | Brain | Sends electrical signals to specific areas of the brain to control seizures | Most effective medical device for epilepsy |
The VNS Therapy System is a small device that is implanted in the chest. It sends electrical signals to the vagus nerve, which runs from the brain to the chest. The vagus nerve is involved in controlling seizures. The VNS Therapy System is approved for the treatment of partial-onset seizures that have not been controlled with medication.
A study published in the journal Epilepsy & Behavior found that the VNS Therapy System was effective in reducing the frequency of seizures in people with epilepsy. The study found that the VNS Therapy System reduced the number of seizures by an average of 50%.
Another study published in the journal Neurology found that the VNS Therapy System was effective in improving quality of life in people with epilepsy. The study found that the VNS Therapy System improved mood, sleep, and social function in people with epilepsy.
Panebianco et al. 2015
“VNS for partial seizures appears to be an effective and well tolerated treatment in 439 included participants from five trials.”
Fisher et al. 2014
“Systematic review of relevant literature provides Class III and IV evidence of the benefit of activating on demand VNS Therapy with a magnet at time of seizure onset.”
Ryvlin et al. 2014
“VNS therapy as a treatment adjunct to BMP (Best Medical Practice) in patients with pharmacoresistant focal seizures was associated with a significant improvement in HRQoL (Health Related Quality f Life) compared with BMP alone.”
Purser et al. 2018
“VNS is a proven intervention that offers a long-term solution for patients with [drugrefractory epilepsy] by reducing seizure frequency, which leads to lower resource utilization and lower costs.”
Clinical trials offer hope for many people and an opportunity to help researchers find better treatments for others in the future. If you are interested in learning more about clinical trials for this device, click here.
Neuropace RNS System
The Neuropace RNS System is a small device that is implanted in the skull. It monitors brain activity and sends electrical signals to the brain to stop seizures before they start. The RNS System is approved for the treatment of partial-onset seizures that have not been controlled with medication.
A study published in the journal Epilepsia found that the Neuropace RNS System was effective in reducing the frequency of seizures in people with epilepsy. The study found that the RNS System reduced the number of seizures by an average of 70%.5
Another study published in the journal Neurology found that the Neuropace RNS System was effective in improving quality of life in people with epilepsy. The study found that the RNS System improved mood, sleep, and social function in people with epilepsy.
Touma et al. 2022
“Neurostimulation modalities are an effective treatment option for drug resistant epilepsy, with improving outcomes over time and few major complications. Seizure reduction rates among the three therapies were similar during the initial blinded phase.”
Clinical trials offer hope for many people and an opportunity to help researchers find better treatments for others in the future. If you are interested in learning more about clinical trials for this device, click here.
Various Devices for Deep Brain Stimulation (DBS)
Some of the FDA cleared DBS devices include Medtronic Activa RC, Medtronic Percept PC, Abbott Infinity 7, Boston Scientific Vercise, and PINS Medical G102. While it has been well established that DBS can safely and effectively treat epilepsy that is resistant to medication, there is no high quality research demonstrating that any of the above mentioned devices is clinically superior to any other.
Deep brain stimulation (DBS) is a neurosurgical procedure that involves implanting electrodes in specific areas of the brain to deliver electrical stimulation. DBS has been used to treat a variety of neurological disorders, including Parkinson’s disease, essential tremor, and dystonia.
In recent years, DBS has also been investigated as a treatment for epilepsy. The results of clinical trials have been promising, with DBS showing efficacy in reducing seizure frequency and improving quality of life in patients with drug-resistant epilepsy.
Li, M., Cook, M 20176.
Deep Brain Stimulation “has been shown to decrease the frequency of refractory seizures. Half of all patients from clinical studies experienced a 46%-90% seizure reduction with ANT-DBS, and a 48%-95% seizure reduction with HC-DBS. Approximately three-fourths of patients receiving stimulation are responders—experiencing a seizure reduction of at least 50%. The time course of clinical benefit varies dramatically, with both an initial lesional effect and ongoing stimulation effect at play. Improved quality of life and changes to cognition or mood may also occur.”
However, it is important to note that DBS is a surgical procedure and there are risks associated with it. These risks include infection, bleeding, and damage to brain tissue. It is important to discuss the risks and benefits of DBS with your doctor before deciding if it is right for you.
Clinical trials offer hope for many people and an opportunity to help researchers find better treatments for others in the future. If you are interested in learning more about clinical trials for these devices, click here.
Frequently Asked Questions
What are implanted devices for epilepsy?
Vagus Nerve Stimulator (VNS) Implants
When seizure medications are ineffective and surgery is not an option, a VNS is used to treat seizures. VNS is made up of a pacemaker-like generator implanted in the chest wall and programmed by the doctor to stimulate the vagus nerve in the neck.
What devices are used to treat epilepsy?
What devices are allowed to be utilised, and who can use them? The FDA has only approved three devices to lessen seizure frequency: Vagus Nerve Stimulation (VNS), Responsive Neurostimulation (RNS), and Deep Brain Stimulation (DBS).
What is the new treatment for drug-resistant epilepsy?
Neuromodulation or neurostimulation devices are now available. The FDA has approved three devices with clear benefits: vagal nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS).
What is the difference between DBS and RNS and VNS?
VNS merely records any additional stimulation that is supplied. DBS records brain impulses known as local field potentials, or LFPs. Only RNS employs electroencephalography (EEG) to measure the electrical activity of the brain – the same monitoring used in medical centres to detect seizures.
What are examples of implanted devices?
Artificial joints, breast implants, cochlear implants, intraocular lenses, pacemakers, other cardiac implants, and intrauterine contraceptive devices are some of the most prevalent implantable medical devices.
What Do We Recommend?
If you are suffering from persistent seizures despite being on Anti-epileptic drugs (AEDs), we highly suggest you seek out a qualified provider who specializes in these implantable devices to discuss whether you would benefit from any of these technologies.
Selected References
- Panebianco, M, Rigby, A, Weston, J, and Marson, AG. Vagus nerve stimulation for partial seizures. Cochrane Database Syst Rev.2015;4:CD002896.
- Fisher, RS, Eggleston, KS, and Wright, CW. Vagus nerve stimulation magnet activation for seizures: A critical review. Acta Neurologica Scandinavica. 2014.
- Ryvlin, P, Gilliam, FG, Nguyen, DK, Colicchio, G, Iudice, A, Tinuper, P, Zamponi, N, Aguglia, U, et al. The long-term effect of vagus nerve stimulation on quality of life in patients with pharmacoresistant focal epilepsy: The PuLsE (Open Prospective Randomized Long-term Effectiveness) trial. Epilepsia. 2014;55(6):893-900.
- Purser, MF, Mladsi, DM, Beckman, A, Barion, F, and Forsey, J. Expected Budget Impact and Health Outcomes of Expanded Use of vagus Nerve Stimulation Therapy for Drug-Resistant Epilepsy. Advances in therapy. 2018. PubMed: 30143957 [PMID]
- Touma, L, Dansereau, B, Chan, AY, Jetté, N, Kwon, CS, Braun, KPJ, Friedman, D, Jehi, L, et al. Neurostimulation in people with drug-resistant epilepsy: Systematic review and meta-analysis from the ILAE Surgical Therapies Commission. Epilepsia. 2022;63(6):1314-1329.
- Li, M., Cook M. Deep brain stimulation for drug-resistant epilepsy. Epilepsia Volume 59, Issue 2Feb 2018 Pagesi-vi, 273-507.
- Benabid, A. L., Pollak, P., Louvet, S., Henry, T., Degos, J. D., & Mauguière, F. (2003). Deep brain stimulation of the anterior nucleus of thalamus for treatment of medically intractable epilepsy. Epilepsia, 44(1), 31-39.
- Theodore, W. H., Fisher, R. S., Blume, W. T., Cross, H. E., Engel, J. Jr, Fisher, R. S., … & Fisher, R. S. (2013). Five-year outcomes of prospective, multicentre trial of anterior thalamic deep brain stimulation for drug-resistant epilepsy. The Lancet Neurology, 12(1), 19-28.
