Direct Deep-Brain Stimulation: First Steps Towards the Feedback Control of Seizures

In many cases, patients with medically intractable epilepsy may not be candidates for respective epilepsy surgery. For example, the epileptic focus may lie within eloquent cortex or there may be multiple distinct epileptic foci. One therapeutic option remains available to these patients: brain stimulation. There is convincing experimental and clinical evidence to indicate that powerful seizure inhibitory mechanisms exist in the brain [757,114,812,184], in particular, diffusely projecting systems from the brainstem. Structures that have been identified as having an inhibitory influence on neocortical and deep interictal and ictal epileptic activity include the caudate nucleus [175,813–827], the cerebellar cortex and deep cerebellar nuclei [174,230,298,302,824,828–845], the caudal reticular formation [184,846,847], the centromedian nucleus of the thalamus [177,848–850], the raphe nuclei [851–854], the locus coeruleus [855–863], the substantia nigra [180,230,864], and the nucleus of the solitary tract via the vagal nerve [178].