Neurostimulation in the Treatment of Epilepsy: A Review of Current and Emerging Therapies

Drug-resistant epilepsy affects approximately one-third of patients with epilepsy, with limited success in achieving seizure freedom after the failure of two antiseizure medications. While resective surgery may offer the best chance for seizure freedom, many patients are not candidates. Neurostimulation is a palliative treatment option for these patients, offering meaningful reductions in seizure frequency and improvements in quality of life. This article explores the mechanisms, efficacy and clinical applications of US Food and Drug Administration–approved neurostimulation therapies, including vagus nerve stimulation, responsive neurostimulation and deep brain stimulation. In addition, we discuss emerging stimulation approaches such as transcranial direct current stimulation, transcranial alternating current stimulation, transcranial magnetic stimulation, epicranial stimulation and external trigeminal nerve stimulation. Further studies are needed to determine which patients are best suited to each type of stimulation, as well as the long-term efficacy and optimal protocols for newer therapies.