Current opinion in neurology
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Curr. Opin. Neurol. · Apr 2006
ReviewBrain stimulation for epilepsy: can scheduled or responsive neurostimulation stop seizures?
Scheduled and responsive direct brain stimulation may be an effective and safe therapy for medically intractable epilepsy. ⋯ Direct brain stimulation appears to be safe and may be efficacious in treating medically intractable epilepsy. The optimal location (deep brain or cortical) and characteristics of the stimulation (frequency, current, duration), and whether stimulation should be focal or responsive are still to be determined. If ongoing studies of a deep brain stimulator and of a cranially implanted responsive neurostimulator demonstrate effectiveness, then neurostimulation may become available as adjunctive therapy for medically intractable epilepsy.
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Only two functionally validated susceptibility genes, CACNA1H and GABRD, have so far been identified in the common epilepsies using a candidate gene approach. The difficulty with the alternative statistical approach, where none of the suggested candidates has been functionally validated, may partly be due to the posited genetic architecture of the common epilepsies, such as the idiopathic generalized epilepsies. A subset of both rare and common variants from a much larger pool of susceptibility genes may contribute to disease risk. We review methods and designs for the genetic dissection of common epilepsies. ⋯ We conclude by emphasizing the importance of deeper endophenotyping using electroclinical, imaging, and molecular approaches to dissect the common epilepsies.
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This review considers the current role of magnetoencephalography in clinical epileptology. ⋯ Magnetoencephalography has been developed to a valuable noninvasive tool in clinical epileptology. The development of approaches which take into account both magnetoencephalography and electroencephalography simultaneously should provide more useful information in the future.