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Spinal Cord Stimulation as a Therapy for Epilepsy

IP.com Disclosure Number: IPCOM000019881D
Publication Date: 2003-Oct-06
Document File: 8 page(s) / 465K

Publishing Venue

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Abstract

Stimulation is applied to the mediolateral (autonomic) column or other parts of the spinal cord to treat epilepsy using an electrode and implantable stimulator. Spinal cord stimulation may be used to increase parasympathetic outflow and/or to decrease sympathetic outflow, both mechanisms of which may have therapeutic benefit in the control of epilepsy. Treatment may alternately or additionally be carried out using an implantable pump and a catheter having a proximal end coupled to the pump and having a discharge portion for infusing therapeutic dosages of drugs for treating epilepsy. Stimulation can increase excitement of the parasympathetic and visceral sensory fibers, thereby treating epilepsy. Low-frequency electrical stimulation is likely to produce such excitement. Infusion with an excitatory parasympathetic neurotransmitter agonist, e.g., acetylcholine or acetylcholine receptor agonist, may also produce this effect. The stimulator may also includes means for sensing epilepsy, e.g., via an EEG sensor.

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Spinal Cord Stimulation as a Therapy for Epilepsy

Background


Epilepsy is characterized by recurrent seizures that can lead to loss of awareness or consciousness, disturbances of movements and sensation, including vision, hearing and taste and disturbances of autonomic function, mood and mental function. Epilepsy afflicts 1 to 2% of the population in the developed world. The mean prevalence of active epilepsy (defined as continuing seizures that need for treatment) in developed and undeveloped countries combined is estimated to be 7 per 1,000 of the general population or approximately 40 million people worldwide. Studies suggest an annual incidence of epilepsy of approximately 50 per 100,000 of the general population in developed countries. However, studies suggest this figure is nearly double at 100 per 100,000 for developing countries.

Epilepsy is often, but not always, the result of an underlying brain disease. Any type of brain disease can cause epilepsy, but not all patients with the same brain pathology will develop epilepsy. While the cause of epilepsy cannot be determined in many patients, the most commonly accepted theory posits that it is the result of an imbalance of certain chemicals in the brain, for example, neurotransmitters. Children and adolescents are more likely to have epilepsy of unknown origin. The older the patient, the more likely it is that the cause is an underlying brain disease such as a brain tumor or cerebrovascular disease. Trauma and brain infection can cause epilepsy at any age and account for the higher incidence rate in developing countries. For example, in Latin America neurocysticercosis (cysts on the brain caused by tapeworm infection) is a common cause. In Africa AIDS and its related infections, as well as malaria and meningitis commonly cause brain injury leading to epilepsy. In India some common causes of brain disease include AIDS, neurocysticercosis and tuberculosis. Febrile illness of any kind, whether or not it involves the brain, can trigger so called febrile convulsions in vulnerable young children. About 5% of such children go on to develop epilepsy in later life. Furthermore, for other brain diseases, only a proportion of sufferers experience seizures as a symptom of such disease. It is suspected, therefore, that those who do experience such symptomatic seizures are more vulnerable to similar biochemical/neurotransmitter etiology.

Recent studies for both developed and developing countries have shown that up to 70% of newly diagnosed children and adults with epilepsy can be successfully treated with anti-epileptic drugs, i.e., complete control of seizures for several years. After two to five years of successful drug treatment, the treatment can be withdrawn in about 70% of children and 60% of adults, without relapse. However, up to 30% of patients are refractory to medication. There is evidence that the longer the history of epilepsy, the more difficult it is to control. The presence of an underl...