Effectiveness of ictal neurostimulation

Background Neurostimulation is an established procedure for the treatment of drug-resistant epilepsies, with results from controlled and uncontrolled clinical trials indicating neuromodulation-mediated efficacy that increases with therapy duration. Acute seizure-interrupting effects are postulated for vagus nerve stimulation (VNS) and for responsive neurostimulation (RNS), and are evaluated for the transcranial focal cortex stimulation (FCS)AimTo review the evidence for acute seizure-interrupting efficacy of different neurostimulation procedures.Materials and methodsLiterature search and presentation of a case study.Results The effectiveness of ictal stimulation has been proven in animal experiments. In clinical application in humans, proof of efficacy under controlled conditions has so far only been achieved on the basis of single case studies. There is preliminary casuistic evidence for the efficacy of ictal FCS.Conclusion There is insufficient evidence for the promising and important therapeutic approach of direct seizure interruption by means of neurostimulation. Although proof of efficacy studies present major methodological challenges, evidence should be improved in study designs under standardized conditions using video-EEG (electroencephalogram) monitoring.