植え込み型電気刺激療法

Implanted Electrical Stimulation

Point

・植え込み型電気刺激デバイスによる神経調節療法は，有効な第三のてんかん外科治療である．

・迷走神経刺激療法はクローズドループ刺激を併用できるようになった．

・脳深部刺激療法や反応性神経刺激療法の導入により，てんかん治療の幅が拡がる．

　Neuromodulation therapy for epilepsy is the third treatment option after medical treatment with antiepileptic drugs and surgical treatment, such as epileptic focal resection. In addition to vagus nerve stimulation（VNS）, deep brain stimulation（DBS）and responsive neurostimulation（RNS）have been approved in several countries. These therapies consist of an implantable device and stimulating electrodes. These therapies have great potential to reduce seizure frequency and severity, improve patients' quality of life, and maintain therapeutic efficacy. When VNS was first introduced, electrical stimulation was set at regular intervals. However, current devices have introduced closed-loop therapy, in which stimulation is performed by detecting seizures. Multi-mode stimulation settings have also been introduced in VNS to adjust patient's seizure characteristics based on the time of the day when seizures are most likely to occur. This review describes the third therapeutic approach for the treatment of epilepsy based on recent research reports.