Deep Brain Stimulation Therapy for Drug-Resistant Epilepsy: Present and Future Perspectives.

Abstract

Drug-resistant epilepsy (DRE) remains a formidable clinical challenge, affecting nearly 30-40% of patients despite optimized pharmacotherapy. In patients for whom resective surgery is contraindicated or poses unacceptable risks, neuromodulatory therapies-most notably deep brain stimulation (DBS)-have emerged as viable and reversible treatment options. This narrative review critically examines the current applications of DBS for DRE, with a focus on major targets including the anterior thalamic nucleus, centromedian nucleus, hippocampus, and emerging targets such as the pulvinar. We provide an in-depth discussion of the therapeutic mechanisms underlying DBS-from local cellular inhibition and desynchronization to widespread network modulation and neuroplasticity induction-and review the latest advances in sensing technologies, patient-specific connectivity mapping, and closed loop stimulation paradigms. In addition to integrating data from randomized controlled trials, long-term observational studies, and advanced imaging investigations, we discuss limitations, persistent challenges, and future research directions that will guide clinical decision-making and optimize therapeutic outcomes.