Toward rational design of electrical stimulation strategies for epilepsy control

Sridhar Sunderam, Bruce Gluckman, Davide Reato, Marom Bikson

Research output: Contribution to journalReview articlepeer-review

81 Scopus citations


Electrical stimulation is emerging as a viable alternative for patients with epilepsy whose seizures are not alleviated by drugs or surgery. Its attractions are temporal and spatial specificity of action, flexibility of waveform parameters and timing, and the perception that its effects are reversible unlike resective surgery. However, despite significant advances in our understanding of mechanisms of neural electrical stimulation, clinical electrotherapy for seizures relies heavily on empirical tuning of parameters and protocols. We highlight concurrent treatment goals with potentially conflicting design constraints that must be resolved when formulating rational strategies for epilepsy electrotherapy, namely, seizure reduction versus cognitive impairment, stimulation efficacy versus tissue safety, and mechanistic insight versus clinical pragmatism. First, treatment markers, objectives, and metrics relevant to electrical stimulation for epilepsy are discussed from a clinical perspective. Then the experimental perspective is presented, with the biophysical mechanisms and modalities of open-loop electrical stimulation, and the potential benefits of closed-loop control for epilepsy.

Original languageEnglish
Pages (from-to)6-22
Number of pages17
JournalEpilepsy and Behavior
Issue number1
StatePublished - Jan 2010

Bibliographical note

Funding Information:
The writing of this article was supported in part by NIH , (grants R01EB001507, R01NS065096, R03NS065451), The Pennsylvania Keystone Innovation Program, The Pennsylvania Tobacco Settlement, The Andy Grove Foundation , and The Epilepsy Foundation . The authors are grateful to Ivan Osorio, M.D., William Stacey, M.D., and Steve L. Weinstein, M.D. for their helpful and insightful comments.


  • Cognitive impairment
  • Control
  • Efficacy
  • Electrical stimulation
  • Electrotherapy
  • Epilepsy
  • Safety
  • Seizure
  • Strategy
  • Treatment marker

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Behavioral Neuroscience


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