Review Article

Evolution and Prospects for Intracranial Pharmacotherapy for Refractory Epilepsies: The Subdural Hybrid Neuroprosthesis

Figure 2

Design of the simplest version of the subdural HNP implant, a nonresponsive intracranial pharmacotherapy device. EEG recording from the treated epileptogenic area provides feedback for the electrophysiological effects of drug pulses during post-implantation device checks, so that ineffective delivery parameters, just as potentially hazardous delivery conditions, can be recognized and corrected. This device might be appropriate for a subclass of patients with drug refractory, surgically untreatable neocortical epilepsy, whose frequently occurring or subjectively predictable seizures may not necessitate the use of a responsive apparatus with seizure-prediction/detection capability. Namely, in these patients automatic, intermittent drug pulses or patient-activated drug deliveries with the above device may provide adequate seizure control without side effects. Since the minipump reservoirs can be refilled via subcutaneous access ports, in each patient more than one AED can be tried and used. Should this strategy prove to be successful in clinical trials, it may well pave the way for the next, responsive version of this device [19].
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