Neuromodulation in Epilepsy

Targeted neuromodulation can be used to reduce seizure frequency in patients with medically intractable epilepsy who are not candidates for surgical resection. Vagus Nerve Stimulation (VNS), Deep Brain Stimulation (DBS), and Responsive Neurostimulation (RNS) can be used for different types of epilepsy and in varied patient populations. The indications differ slightly, and each requires unique surgical approaches. All require the placement of a pulse generator in an accessible location, and precise placement of electrodes at a target point in the nervous system. The procedures are well tolerated, and have risks comparable to other similar operations. In this chapter, we review the indications and anticipated benefit for each mode of neuromodulation.