For the one third of people with epilepsy whose seizures are not controlled with medications, targeting the seizure focus with neurostimulation can be an effective therapeutic strategy. In this focused review, we summarize a discussion of targeted neurostimulation modalities during a workshop held in Frankfurt, Germany in September 2023. Topics covered include: available devices for seizure focus stimulation; alternating current (AC) and direct current (DC) stimulation to reduce focal cortical excitability; modeling approaches to simulate DC stimulation; reconciling the efficacy of focal stimulation with the network theory of epilepsy; and the emerging concept of ‘neurostimulation zones,’ which are defined as cortical regions where focal stimulation is most effective for reducing seizures and which may or may not directly involve the seizure onset zone. By combining experimental data, modeling results, and clinical outcome analysis, rational selection of target regions and stimulation parameters is increasingly feasible, paving the way for a broader use of neurostimulation for epilepsy in the future.

中文翻译：

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针对癫痫焦点的神经刺激：当前的治疗理解和观点

对于三分之一无法通过药物控制癫痫发作的癫痫患者来说，通过神经刺激瞄准癫痫病灶可能是一种有效的治疗策略。在这篇重点综述中，我们总结了 2023 年 9 月在德国法兰克福举行的研讨会期间对靶向神经刺激方式的讨论。涵盖的主题包括：用于癫痫焦点刺激的可用设备；交流电 (AC) 和直流电 (DC) 刺激可降低局灶性皮质兴奋性；模拟直流刺激的建模方法；协调局灶刺激的疗效与癫痫网络理论；以及新兴的“神经刺激区”概念，其定义为局灶性刺激对于减少癫痫发作最有效的皮质区域，并且可能或可能不直接涉及癫痫发作区。通过结合实验数据、建模结果和临床结果分析，合理选择目标区域和刺激参数变得越来越可行，为未来更广泛地使用神经刺激治疗癫痫铺平了道路。