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Author Notes:

Correspondence: Abhijeet Gummadavelli, Yale Department of Neurosurgery, 333 Cedar St., New Haven, CT 06520-8018. email: abhijeet. gummadavelli@yale.edu.

Author Contributions: Conception and design: Gummadavelli, Kundishora.

Acquisition of data: Gummadavelli, Kundishora, Andrews.

Analysis and interpretation of data: Gummadavelli, Kundishora, Andrews.

Drafting the article: Gummadavelli, Kundishora, Willie, Andrews, Gerrard, Blumenfeld.

Critically revising the article: Gummadavelli, Kundishora, Willie, Andrews, Gerrard, Blumenfeld.

Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Gummadavelli.

Administrative/technical/material support: Gummadavelli, Kundishora. Study supervision: Spencer, Blumenfeld.

Mr. Gummadavelli and Mr. Kundishora contributed equally to this work.

Dr. Willie is a consultant for Monteris Medical and MRI Interventions.

Dr. Gerard is a consultant for Medtronic.

Subjects:

Research Funding:

This work was supported by Howard Hughes Medical Institutes—Citizens United for Research in Epilepsy Medical Student Fellowships (to A.G. and A.K), NIH R01 NS066974 (to H.B.), R21 NS083783 (to H.B.), the Loughridge-Williams Foundation, and by the Betsy and Jonathan Blattmachr Family.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Surgery
  • Neurosciences & Neurology
  • level of consciousness
  • arousal
  • epilepsy
  • deep brain stimulation
  • DBS
  • DEEP BRAIN-STIMULATION
  • CENTROMEDIAN THALAMIC NUCLEUS
  • CHRONIC ELECTRICAL-STIMULATION
  • PEDUNCULOPONTINE TEGMENTAL NUCLEUS
  • VENTROLATERAL PREOPTIC NUCLEUS
  • CHILDHOOD ABSENCE SEIZURES
  • TEMPORAL-LOBE EPILEPSY
  • SLEEP-WAKE CONTROL
  • BASAL FOREBRAIN
  • PARKINSONS-DISEASE

Neurostimulation to improve level of consciousness in patients with epilepsy

Tools:

Journal Title:

Neurosurgical focus

Volume:

Volume 38, Number 6

Publisher:

, Pages E10-E10

Type of Work:

Article | Final Publisher PDF

Abstract:

When drug-resistant epilepsy is poorly localized or surgical resection is contraindicated, current neurostimulation strategies such as deep brain stimulation and vagal nerve stimulation can palliate the frequency or severity of seizures. However, despite medical and neuromodulatory therapy, a significant proportion of patients continue to experience disabling seizures that impair awareness, causing disability and risking injury or sudden unexplained death. We propose a novel strategy in which neuromodulation is used not only to reduce seizures but also to ameliorate impaired consciousness when the patient is in the ictal and postictal states. Improving or preventing alterations in level of consciousness may have an effect on morbidity (e.g., accidents, drownings, falls), risk for death, and quality of life. Recent studies may have elucidated underlying networks and mechanisms of impaired consciousness and yield potential novel targets for neuromodulation. The feasibility, benefits, and pitfalls of potential deep brain stimulation targets are illustrated in human and animal studies involving minimally conscious/vegetative states, movement disorders, depth of anesthesia, sleep-wake regulation, and epilepsy. We review evidence that viable therapeutic targets for impaired consciousness associated with seizures may be provided by key nodes of the consciousness system in the brainstem reticular activating system, hypothalamus, basal ganglia, thalamus, and basal forebrain.

Copyright information:

© AANS, 2015.

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