Deep brain stimulation for refractory epilepsy in adults

Evidence on the safety and efficacy of deep brain stimulation for refractory epilepsy in adults differs according to the site of stimulation:

• For anterior thalamic targets the evidence is limited in quantity and quality, therefore this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE website.

• For targets other than the anterior thalamus the evidence is inadequate in quantity and quality, therefore this procedure should only be used in the context of research. Find out what only in research means on the NICE website.

Clinicians wishing to do deep brain stimulation of anterior thalamic targets for refractory epilepsy in adults should:

• Inform the clinical governance leads in their NHS trusts.

• Give patients clear written information to support shared decision making, including NICE's information for the public.

• Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these.

• Audit and review clinical outcomes of all patients having the procedure. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion).

Patient selection should be done by a multidisciplinary team experienced in managing epilepsy including a neurologist, neurophysiologist and neurosurgeon.

The procedure should only be done in neurosurgery centres that specialise in managing epilepsy.

Further research should describe patient selection and clearly define the target area of the brain. Outcomes should include reduction in seizure frequency and improvement in the epilepsy seizure outcome scale, quality of life, reduction in concomitant medication and hospital admissions.