A comparison of drug treatment versus electrical stimulation for suppressing seizure activity

Currently, the management of seizure activity by using pharmacological approaches is in many cases successful. However, it is also known that some patients (up to 30%) do not respond to conventional treatment and are considered drug resistant. For this group other approaches are sometimes attempted, such as surgical resection (not reviewed here) or use of the ketogenic diet (also not reviewed here). More recently, though, procedures that utilize chronic electrical stimulation as a means for suppressing seizure events are being tried. Experiments based on electrical stimulation are being conducted in both animal models and in some limited human trials, but so far it has not been determined if chronic electrical stimulation is more or less effective than conventional drug therapy. This article reviews basic mechanisms of seizure activity, standard antiepileptic drugs (AEDs), and compares conventional AEDs to alternative approaches such as vagal nerve and deep brain stimulation.