Living with treatment-resistant epilepsy can make everyday life feel unpredictable. A normal day at work, cooking dinner, taking a shower, or walking across a parking lot can be interrupted without warning by a seizure, the recovery afterward, or the fear that one might happen. It is not a lack of willpower, it is not “just stress,” and it is not your fault. Epilepsy, especially when medicines do not fully control seizures, comes from complex changes in how brain cells send signals. For some people with severe, ongoing seizures, deep brain stimulation (DBS) becomes one of the treatment options their care team may consider.
 

This Treatment-Resistant Epilepsy Hub is here to give you clear information about seizure types, treatment options, and how DBS may be used to help manage seizures when other treatments have not worked well enough, so you do not have to sort through it on your own. Below you will find condition-specific links focused on epilepsy and related seizure disorders, along with tools to help you prepare for visits, understand your options, and bring better questions to your own medical team. Our goal is to turn some of the fear and uncertainty in your day into steadier ground by offering language, knowledge, and practical support.

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What is treatment-resistant focal epilepsy?

Treatment-resistant focal epilepsy, also called drug-resistant epilepsy, is a clinical term used when seizures keep happening even after trying at least two anti-seizure medicines that were appropriate for the seizure type, taken at reasonable doses, and tolerated.¹ This definition is widely used because it creates a clear “pivot point,” a moment when the plan should widen beyond repeating medication changes alone.¹²

It also matters because ongoing uncontrolled seizures can affect safety, independence, mood, memory, work, and relationships, even when the seizures look “small” from the outside. The goal of naming drug resistance is not to label you, it is to open doors to a deeper workup and a fuller menu of evidence-based options, including epilepsy surgery and device therapies like RNS, VNS, and DBS.²³

What does “focal” mean in focal epilepsy?

“Focal” means seizures start in one specific area of the brain, sometimes called the seizure focus or seizure onset zone.⁴ A focal seizure can stay limited to that area, causing symptoms like odd sensations, sudden emotion, speech changes, or a brief “blank” spell, or it can spread to other parts of the brain and affect awareness or body movement.⁴

Focal epilepsy is often connected to a brain finding such as hippocampal sclerosis (scarring in the temporal lobe), prior stroke or injury, a developmental brain difference, or another structural change seen on MRI.⁵⁶ When the start point and cause are clearer, the care team can more confidently discuss targeted treatments, including surgical approaches or neurostimulation.⁵⁶

How do clinicians decide when epilepsy is “drug-resistant”?

The most commonly cited definition comes from the International League Against Epilepsy (ILAE): failure of adequate trials of two tolerated and appropriately chosen and used anti-seizure medicine schedules to achieve sustained seizure freedom.¹ The words “adequate” and “appropriately chosen” matter, because a medication that is effective for one seizure type may not be effective, or may even worsen seizures, in another seizure type.¹

After two well-chosen medication trials fail, the likelihood of achieving lasting seizure freedom with additional medication trials alone tends to be lower for many patients, which is why professional guidance emphasizes timely referral for advanced evaluation.³⁷ This does not mean “no hope,” it means the plan shifts from trying to out-muscle seizures with medication alone to carefully mapping where seizures start, why they start, and what interventions best match the pattern.³⁶

What are common reasons focal seizures continue despite medication?

Sometimes the brain area generating seizures is structurally abnormal or scarred, and medication can reduce seizures but may not fully stop that focal source.⁵⁶ In other cases, seizures arise from more than one focus, or from a network that spreads quickly, making seizure control harder even with multiple medicines.⁵⁶

Another important reason is diagnostic mismatch. Some events that look like seizures may be non-epileptic spells, fainting, sleep-related events, movement disorders, or medication side effects. Comprehensive evaluation, especially video EEG monitoring, is designed to reduce guesswork by matching the story of events to brainwave evidence.⁶

When should someone consider a comprehensive epilepsy center evaluation?

If focal seizures continue after two appropriate anti-seizure medicines, expert consensus recommends referral for evaluation at a center that can assess surgical and device options.³ This is true even if surgery feels scary, or if you assume you will not qualify. A referral is not a commitment, it is a way to get clear answers and a realistic plan.³

Quality measures from major neurology organizations have also emphasized that delays in referral are common and can stretch for many years, even when advanced therapies could have been discussed earlier.⁷ This is one of those moments where the fog can thicken if you stay on the same road, or you can step into a brighter room with more tools, more testing, and more specialized experience.³⁷

What is a comprehensive epilepsy center, and what do “Level 3” and “Level 4” mean?

In the US, the National Association of Epilepsy Centers (NAEC) accredits Level 3 and Level 4 centers.⁸ Level 3 centers provide specialized testing and a multidisciplinary team to diagnose and treat refractory epilepsy, including services such as neuropsychology and psychosocial support, and some Level 3 centers offer certain surgical procedures.⁸

Level 4 centers provide the most complex evaluation and treatment options, which commonly include advanced imaging, intracranial EEG monitoring when needed, and access to a full range of surgical and neuromodulation therapies.⁸ If your seizures remain uncontrolled, Level 4 centers are often the place where the widest set of options can be evaluated in one coordinated workflow.⁸

What tests are commonly used to evaluate treatment-resistant focal epilepsy?

The purpose of advanced testing is to answer two questions with evidence: where seizures start, and whether that start point can be treated safely and effectively.⁶ A common foundation is inpatient video EEG monitoring in an epilepsy monitoring unit (EMU), where EEG brain activity is recorded continuously while video captures the physical signs of typical events.⁶

MRI is also central, because it can reveal lesions or scarring that guide diagnosis and treatment planning.⁶ Many evaluations also use additional tools when appropriate, such as PET or SPECT imaging to support localization, and neuropsychological testing to understand memory and language strengths and risks, especially when the suspected focus is near areas that support speaking or remembering.⁶

What is an epilepsy monitoring unit, and why is video EEG so important?

An EMU stay allows the team to record typical events while tracking brainwaves and behavior at the same time.⁶ That combination can confirm whether events are epileptic seizures, and it can help localize where seizures begin and how they spread.⁶ This step is often the difference between “we think” and “we know,” which changes the entire decision pathway.⁶

During monitoring, the team may adjust medication under supervision to increase the chance of capturing events safely in the hospital setting.⁶ This is done with careful safety planning because seizures can intensify when medicines change. EMU monitoring is not about provoking danger, it is about gathering the evidence needed for safer, more effective long-term decisions.⁶

What is “presurgical evaluation,” and does it mean someone is definitely getting surgery?

A presurgical evaluation is a structured process that determines whether a procedural treatment might help, and if so, which option matches the person’s seizure onset pattern and risk profile.³⁶ It does not mean someone is “definitely getting surgery.” It means the team is building a clear map before anyone talks about cutting, burning, or implanting anything.³

Many people complete presurgical evaluation and are not candidates for a brain tissue removal procedure, but still benefit from improved diagnosis, better-targeted medication choices, and consideration of device-based neuromodulation such as RNS, VNS, or DBS.³⁶ That is why expert guidance stresses that evaluation itself is valuable, even when the final recommendation is not surgery.³

What treatment paths exist beyond trying more medications?

For treatment-resistant focal epilepsy, advanced options often fall into three categories: resective surgery (removing the seizure-generating area when it can be done safely), ablative therapies (such as laser interstitial thermal therapy in selected cases), and neuromodulation (implanted devices that reduce seizures by influencing nerve or brain networks).³⁶⁹

Neuromodulation options approved in the US for drug-resistant focal epilepsy include vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT).¹⁰¹¹¹² Which path fits best depends on localization, number of seizure foci, MRI findings, and how close the suspected seizure onset zone is to brain regions responsible for language, movement, or memory.³⁶

How effective is epilepsy surgery for some focal epilepsies?

For some focal epilepsies, especially well-localized temporal lobe epilepsy, surgery can provide a higher chance of seizure freedom than continued medication-only care. In a randomized controlled trial, surgery for temporal lobe epilepsy outperformed continued medical therapy at one year in seizure outcomes.¹³

This does not mean surgery is right for everyone. Outcomes vary based on seizure location and brain findings, and surgery carries risks that must be weighed carefully. Still, expert consensus emphasizes timely referral, because long delays can mean years of ongoing seizures when a potentially more effective treatment could have been evaluated earlier.³⁷

What is neurostimulation, and how is it different from resective surgery?

Neurostimulation, also called neuromodulation, uses an implanted device to deliver electrical pulses that aim to reduce seizure frequency and severity. It usually does not remove brain tissue. Instead, it attempts to change the brain network conditions that make seizures more likely, over time.⁹¹⁰

This approach is often considered when seizures start in areas that cannot be safely removed, when seizures arise from more than one focus, or when seizure onset is difficult to pinpoint to a single removable region.⁹¹⁰ The realistic goal is often meaningful seizure reduction and improved quality of life, rather than a guaranteed cure, although some people do experience long seizure-free intervals.⁹¹⁴

What is vagus nerve stimulation (VNS), and how is it used for focal epilepsy?

VNS is an implanted system that stimulates the vagus nerve in the neck, which can influence brain networks involved in seizure activity.¹¹ It is not aimed at a single seizure focus in the brain, so it is often considered when seizures are hard to localize or when a broad network approach is preferred.⁹¹¹

In the US, FDA approval describes VNS as an adjunctive therapy to reduce seizure frequency in patients with refractory partial-onset seizures, with age and device-specific details described in the approval documents.¹¹ Evidence reviews and long-term experience support VNS as an established neuromodulation option for drug-resistant epilepsy, with outcomes that often improve over time for many patients.⁹¹⁵

What is responsive neurostimulation (RNS), and who is it for?

RNS is an implanted system that monitors brain activity and delivers stimulation when it detects patterns that suggest a seizure is starting, which is why it is often called “closed-loop” stimulation.¹²¹⁶ This approach is typically discussed when testing suggests one or two seizure foci that can be targeted with electrodes, but removal of that tissue is not safe or not desired.¹²¹⁶

FDA labeling describes RNS as an adjunctive therapy for adults with partial-onset seizures and defined seizure foci, among other criteria in the device documentation.¹² Clinical trials have shown that responsive stimulation can reduce disabling partial seizures and can be associated with quality-of-life improvement, with seizure reduction often increasing over longer-term follow-up.¹⁶¹⁷

What is deep brain stimulation (DBS) for epilepsy, and what does it target?

DBS for epilepsy most commonly refers to stimulation of the anterior nucleus of the thalamus (ANT). The thalamus acts like a major relay and coordination center for brain networks, and ANT is connected to circuits that can participate in seizure spread. This is why ANT-DBS is considered a “network” therapy, even though the electrodes sit in a specific deep target.⁹¹⁴¹⁸

In the US, FDA approval indicates ANT-DBS as an adjunctive therapy to reduce seizure frequency in adults (18 or older) with epilepsy characterized by partial-onset seizures, with or without secondary generalization, that are refractory to three or more anti-seizure medications, and with additional criteria in the approval summary.¹⁴¹⁹ This is a key point to hold gently but clearly: DBS is not a “last resort after everything,” it is a specific tool for a specific pattern of drug-resistant epilepsy, considered after specialized evaluation confirms the fit.¹⁴¹⁹

What evidence supports DBS of the anterior nucleus of the thalamus (ANT-DBS) for treatment-resistant focal epilepsy?

The largest foundational trial is the SANTÉ study (Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy), a multicenter randomized trial that showed greater seizure reduction in the stimulated group compared with controls during the blinded phase, followed by continued improvement over longer-term follow-up.⁹ The trial included adults with medically refractory partial seizures, including seizures that secondarily generalized.⁹

Long-term follow-up publications from the SANTÉ cohort reported sustained seizure reduction at 5 years and at 7 to 10 years, with responder rates and median seizure reduction generally improving over time in the followed group.¹⁸²⁰ These long-term reports also describe safety outcomes and include discussion of serious device-related adverse events, and SUDEP rates observed in the cohort.¹⁸²⁰ This long-term evidence base is one reason ANT-DBS is considered a durable option for some people with drug-resistant focal epilepsy when other approaches are not a match.⁹¹⁸²⁰

What does “DBS candidacy” usually involve for epilepsy?
DBS candidacy is not decided by one test or one visit. It typically follows a comprehensive epilepsy evaluation that clarifies seizure type, confirms drug resistance, and determines whether seizures are focal-onset and whether resection or ablation is safe or likely to help.³⁶ This evaluation often includes EMU monitoring, MRI, and sometimes additional imaging or neuropsychological testing, depending on the situation.⁶

For DBS specifically in the US, FDA approval documents outline key eligibility features used in the approved indication, such as adult age, partial-onset seizures, medication refractoriness, and baseline seizure frequency thresholds described in approval summaries.¹⁴¹⁹ Your clinician can translate those criteria into your real-life situation, including how your seizure diary, testing results, and treatment history line up with the indication and the evidence base.¹⁴¹⁹

How does the DBS system for epilepsy work, in plain language?

A DBS system has three main parts: thin electrodes (leads) placed in the brain target, extension wires that run under the skin, and a pulse generator (like a pacemaker for the brain) usually implanted in the chest.¹⁴¹⁹ The generator sends pulses up the wires to the brain electrodes, and those pulses influence network activity in a way that can reduce seizure frequency or severity over time.⁹¹⁸

For epilepsy, ANT-DBS is typically programmed to stimulate on a schedule rather than responding moment-to-moment to detected seizure patterns, which is one way it differs from RNS.⁹¹⁶ Many people do not feel the stimulation itself. If side effects occur, they may relate to stimulation settings, lead location, or individual sensitivity, and the clinical approach is usually to adjust programming in a stepwise way.⁹¹⁸²¹

What is the DBS implantation process like, from evaluation to recovery?

The process generally starts with confirmation that seizures are drug-resistant and focal-onset, followed by imaging and planning to target the anterior nucleus of the thalamus.³⁶¹⁴ Surgery involves placing the brain leads and connecting them to the implanted generator, with procedural details varying by center and surgeon.¹⁴²¹

After implantation, DBS is not “one-and-done.” It requires follow-up programming visits where clinicians adjust settings over time to balance seizure reduction and side effects, and it may take months to see the full pattern of benefit.⁹¹⁸²¹ This is a long road, but it is a road with steerable handlebars, meaning the therapy can often be tuned rather than accepted as fixed.²¹

What benefits are realistic to expect from ANT-DBS for epilepsy?

In studies of ANT-DBS, many patients experienced meaningful seizure reduction over time, and longer-term follow-up shows that improvements can be sustained across years for those who remain in follow-up.⁹¹⁸²⁰ That said, DBS is not guaranteed to stop seizures completely, and different people respond differently based on seizure network patterns, prior surgeries, and individual factors.⁹¹⁸

A useful, steady framing for many families is: fewer seizures, less severe seizures, shorter recovery after seizures, and fewer disruptions to daily life.²¹ When thinking about outcomes, it can help to define what “meaningful” looks like for you, for example fewer injuries, fewer emergency visits, fewer convulsive seizures, or more reliable days, and bring those goals into the discussion with your epilepsy team.³⁶

What are the risks and side effects of DBS for epilepsy?

DBS carries risks related to surgery and to having an implanted device. Surgical risks can include bleeding in the brain, infection, and anesthesia-related complications, and device risks can include hardware problems that may require additional procedures.¹⁸¹⁹ Safety reporting from SANTÉ long-term follow-up describes serious device-related adverse events across years of treatment, which is part of how clinicians counsel patients about realistic risk.¹⁸¹⁹

DBS can also have stimulation-related side effects. In SANTÉ, cognition and mood did not show group differences overall, but some participants reported depression or memory problems as adverse events, which is why mood and cognition deserve honest, individualized discussion before and after implant.⁹ This is not meant to alarm, it is meant to remove the mask and speak plainly: for many people DBS is tolerable and beneficial, but your brain is not a machine, and your care plan should include mental health screening and follow-up as part of whole-person epilepsy care.⁹²¹

How is DBS programming done, and why can it take time?

Programming means adjusting the stimulation settings, such as which contacts are active and the strength and timing of pulses.²¹ The goal is to find a “therapeutic window,” a setting range that reduces seizures while minimizing side effects.²¹ This often takes multiple visits because the brain’s response can evolve, and because seizure patterns can change gradually.²¹

A practical review of epilepsy neuromodulation emphasizes that outpatient management and iterative programming are central to device success, and that device selection and programming strategy should match the person’s seizure pattern and goals.²¹ If you are considering DBS, it is reasonable to ask what the follow-up schedule typically looks like at your center and who you will contact if side effects or seizure changes occur.²¹

How do clinicians choose between DBS, RNS, and VNS?

The biggest driver is the seizure map. If seizures arise from one or two identifiable foci that can be targeted, RNS may be considered because it can monitor and respond to activity at or near the seizure onset zone.¹²¹⁶ If seizures are more distributed, not well localized, or involve broader networks, VNS or DBS may be considered because they influence networks rather than one cortical focus.⁹²¹

Other factors also matter: MRI findings, prior surgeries, seizure types, coexisting depression or sleep problems, age, and device-specific eligibility and contraindications described in labeling and clinical practice.¹¹¹²¹⁴ A practical review highlights that selection is often about matching the device’s strengths to the person’s epilepsy “shape,” not about choosing the “best device” in the abstract.²¹

What should someone track before an advanced epilepsy appointment?

Tracking does not need to be perfect, it needs to be consistent enough to show patterns. Seizure diaries are used in trials and clinical care to measure change over time, and they remain one of the most practical tools for shared decision-making.¹⁸

Making a list, and you can use the list below as an example of what to include, is meant to help your team understand frequency, severity, triggers, and medication effects, so decisions are based on your real life, not on memory under stress.⁶
 

• Seizure dates, times, and duration, plus a short description of what happened before, during, and after.⁶

• Awareness changes, injuries, and how long recovery took.⁶

• Possible triggers like sleep loss, missed doses, illness, alcohol, or stress, if patterns repeat.⁶

• Medication list, doses, side effects, and what has been tried previously.¹

• Videos of events when safe to capture, because they can help interpretation alongside EEG.⁶

What questions are worth bringing, especially if DBS is on the table?

Questions are how you pull light through the cracks. They help you see what is known, what is uncertain, and what the next step actually is.

Here are some questions to ask your medical team:

• Do I meet the ILAE definition of drug-resistant epilepsy, and what evidence supports that in my case?¹³

• Where do you think my seizures start, and how confident are you, based on video EEG and imaging?⁶

• Am I a candidate for resection or ablation, and if not, why not?³⁶

• If DBS is being considered, do I match the FDA-indicated profile and the evidence base, and what would be my realistic goals?¹⁴¹⁸

• What are the center’s typical DBS complication rates, and how are infections or hardware issues handled if they occur?¹⁸¹⁹

• How often will programming visits happen in the first year, and who manages urgent troubleshooting?²¹

• What side effects should I watch for, including mood or memory changes, and how would we respond?⁹²¹

• How might DBS affect the most severe seizure type I have, and what does the long-term data show?²⁰

How do safety and emergency planning fit into treatment-resistant focal epilepsy care?

Safety planning is part of good care, not a sign of fear. It commonly includes seizure first aid, reducing risks around water, heights, and heat, and planning for how family or coworkers should respond during a seizure.⁶ This planning also includes discussions about driving rules, which vary by state and depend on seizure control, and should be discussed with your clinician based on your local regulations.⁶

SUDEP, sudden unexpected death in epilepsy, is often discussed in a balanced, individualized way. Practice guidelines identify generalized tonic-clonic seizures and their frequency as a major risk factor, and emphasize that counseling should be tailored to the person’s epilepsy type and circumstances.²²²³ The goal is informed, calm risk reduction, not panic.²³

What should people know about country differences in DBS availability and care pathways?

In the US, DBS for epilepsy is defined by FDA approval and labeling, including the specific target (anterior nucleus of the thalamus) and the eligibility features described in approval summaries.¹⁴¹⁹ Outside the US, device approvals, funding, and care pathways can differ, sometimes substantially.¹⁴

If you live outside the US, a practical next step is to ask your clinician which neuromodulation therapies are approved and available locally, which centers implant them, and what evaluation steps are required before device consideration.⁸²¹

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SAFETY NOTE
If symptoms are urgent, sudden, or severe, such as a seizure that lasts a long time, repeated seizures without recovery, serious injury, breathing problems, or a first-time seizure, seek emergency care right away. If you are unsure, it is safer to get checked urgently.

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GLOSSARY

Ablation: A procedure that destroys a small area of tissue, sometimes used to target a seizure focus in selected cases.
Adjunctive therapy: A treatment used in addition to other treatments, not as the only therapy.
Anterior Nucleus of the Thalamus: A deep brain region connected to seizure-related networks, a common DBS target for epilepsy.
Anti-seizure medicine: Medication used to reduce seizure frequency or severity, also called antiseizure medication.
Closed-loop stimulation: Stimulation that responds to detected brain activity patterns rather than running on a fixed schedule.
Comprehensive epilepsy center: A specialized center with advanced testing and teams that evaluate surgery and device options for difficult-to-control epilepsy.
Deep brain stimulation: A therapy using implanted electrodes and a pulse generator to deliver stimulation to deep brain targets.
Drug-resistant epilepsy: Epilepsy in which seizures continue despite adequate trials of at least two appropriate anti-seizure medicines.
Electroencephalogram: A test that records brain electrical activity using sensors on the scalp, also called EEG.
Epilepsy monitoring unit: A hospital unit where seizures are recorded using continuous EEG and video to clarify diagnosis and localization.
Focal epilepsy: Epilepsy in which seizures start in one specific area of the brain.
Focal seizure: A seizure that begins in one area of the brain, sometimes spreading to other regions.
Intracranial EEG: EEG recorded using electrodes placed on or in the brain to better localize seizure onset.
Laser interstitial thermal therapy: A minimally invasive procedure that uses heat to target selected brain tissue.
Magnetic resonance imaging: A brain imaging test, also called MRI, that can show structural causes of seizures.
Neuromodulation: A therapy that changes nervous system activity using implanted electrical stimulation.
Neurostimulation: Another term for neuromodulation, using electrical pulses to influence nerve or brain signaling.
Partial-onset seizures: A term often used in device labeling that generally corresponds to focal seizures.
Presurgical evaluation: Tests used to determine whether a surgical or procedural treatment could help and what risks are involved.
Responsive neurostimulation: An implanted brain device that detects seizure-like activity and delivers stimulation in response.
Seizure diary: A record of seizure timing, type, severity, and recovery used to track patterns and treatment impact.
Seizure onset zone: The brain area where seizures begin.
SUDEP: Sudden unexpected death in epilepsy, a rare, sudden death in someone with epilepsy not explained by another cause.
Vagus nerve stimulation: An implanted device that stimulates the vagus nerve in the neck to reduce seizures by influencing brain networks.
Video EEG: EEG recorded at the same time as video, used to match symptoms with brainwave changes.

 

REFERENCES
 

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6. Epilepsy Foundation. Tests Before Surgery for Seizures. https://www.epilepsy.com/treatment/surgery/tests-surgery

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8. National Association of Epilepsy Centers. What are Epilepsy Centers and How can they Help? https://naec-epilepsy.org/what-are-epilepsy-centers-and-how-can-they-help

9. Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia. 2010;51(5):899-908. doi: https://doi.org/10.1111/j.1528-1167.2010.02536.x

10. Fisher RS. Deep brain stimulation of thalamus for epilepsy. Seizure. 2023;109:74-83. doi: https://doi.org/10.1016/j.seizure.2023.02.009

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12. US Food and Drug Administration. NeuroPace RNS System, labeling and device information (P100026). https://www.accessdata.fda.gov/cdrh_docs/pdf10/p100026c.pdf

13. Jobst BC, Cascino GD. Resective epilepsy surgery for drug-resistant focal epilepsy: a review. JAMA. 2015;313(3):285-293. doi: https://doi.org/10.1001/jama.2014.17426

14. US Food and Drug Administration. Premarket Approval (PMA): Medtronic DBS System for Epilepsy (P960009/S219). https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=p960009s219

15. Afra P, Adamolekun B, Agarwal S, et al. Evolution of the vagus nerve stimulation therapy system technology for drug-resistant epilepsy. Front Med (Lausanne). 2021;8:696780. doi: https://doi.org/10.3389/fmed.2021.696780

16. Morrell MJ; RNS System in Epilepsy Study Group. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology. 2011;77(13):1295-1304. doi: https://www.neurology.org/doi/10.1212/WNL.0b013e3182302056

17. Heck CN, King-Stephens D, Massey AD, et al. Two-year seizure reduction in adults with medically intractable partial onset epilepsy treated with responsive neurostimulation: final results of the RNS System Pivotal trial. Epilepsia. 2014;55(3):432-441. doi: https://doi.org/10.1111/epi.12534

18. Salanova V, Witt T, Worth R, et al. Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy. Neurology. 2015;84(10):1017-1025. doi: https://doi.org/10.1212/WNL.0000000000001334

19. US Food and Drug Administration. Summary of Safety and Effectiveness Data (SSED): Medtronic DBS System for Epilepsy, PMA P960009/S219. https://www.accessdata.fda.gov/cdrh_docs/pdf/P960009S219b.pdf

20. King-Stephens D, Mirro E, Weber PB, et al. Long Term Safety and Efficacy of Anterior Nucleus of the Thalamus Stimulation for Drug-Resistant Epilepsy. Neuromodulation. 2021;24(5):957-965. https://pmc.ncbi.nlm.nih.gov/articles/PMC8655256/

21. Simpson HD, Daly JJ, Pal Attia T, et al. Practical considerations in epilepsy neurostimulation. Epilepsy Behav. 2022;136:108917. doi: https://doi.org/10.1016/j.yebeh.2022.108917

22. Harden C, Tomson T, Gloss D, et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors. Neurology. 2017;88(17):1674-1680. doi: https://pubmed.ncbi.nlm.nih.gov/28438841/

23. American Epilepsy Society. Position Statement on SUDEP Counseling. https://aesnet.org/about/about-aes/position-statements/position-statement-on-sudep-counseling