Neuromodulation
Vagus nerve stimulation (VNS):The last surgical procedure that can be done to help prevent the reoccurrence of seizures in the frontal lobes is to implant a stimulator on the vagus nerve. This device is a self-activating device that is inserted directly under the skin and can be controlled directly by the patient. When a patient is feeling the onset of an aura, he/she can activate the stimulator which in turn will provide stimulation to the left vagus nerve (the left vagus nerve is used because the right nerve plays a role in cardiac function). Although little is understood about the exact mechanism for vagal nerve stimulation, it has been proven to be a successful treatment that can often terminate seizures before they begin. It has the potential of being helpful in patients with resistance to AEDs.This procedure named Deep brain stimulation (DBS) another novel procedure that can be used utilizes a mechanism similar to that of a cardiac pacemaker The electrode is implanted into the patients brain, while a neuro-stimulator machine is placed beneath the skin of the chest. The stimulator sends an indication to the electrode in the brain to prevent any signal that potentially triggers or can trigger a seizure.Surgeries have been used as a treatment for FLE, however, meta-analyses have shown that proper etiological studies are important to give best postoperative results, with children <3 years of age showing pathology and location of the surgery as important factors.
This process is extremely efficient and entirely non-invasive and is therefore much safer than actual neurosurgery itself. Recently researchers and surgeons alike have begun to use Gamma Knife radiosurgery to treat cases of epilepsy by removing tumors responsible for causing the seizures. The early success rates in being able to alleviate seizures seem to be similar to those of temporal resective surgery however Gamma Knife radiosurgery has less associated risk factors. Current research on this topic is aimed at improving the technique in order to increase success rates as well as developing non-invasive forms of physiologic monitoring in order to determine the epileptogenic focus conclusively.Another way of understanding or studying FLE, highly under study is the network approach. When conventional imaging does not show the structural lesions, HFO analysis shows the pathophysiology, locally at the neural circuit level. Genetic analysis along with neuroimaging like fMRI, EEG, MEG, and in-depth semiological analysis, aids in the network approach study of FLE, both at micro and macro levels, giving it a comprehensive view. References
External links
Frontal lobe epilepsy on Epilepsy.com
Epilepsy Foundation