1 Guidance

1 Guidance

1.1 The evidence on the efficacy of deep brain stimulation (DBS) for refractory epilepsy is limited in both quantity and quality. The evidence on safety shows that there are serious but well-known side effects. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.

1.2 Clinicians wishing to undertake DBS for refractory epilepsy should take the following actions.

  • Inform the clinical governance leads in their Trusts.

  • Ensure that patients and their carers understand the uncertainty about the procedure's safety and provide them with clear written information. In addition, the use of NICE's information for patients ('Understanding NICE guidance') is recommended.

  • Audit and review clinical outcomes of all patients having DBS for refractory epilepsy (see section 3.1).

1.3 Patient selection, treatment and follow-up should be carried out by a multidisciplinary team specialising in the management of difficult epilepsy, including a neurologist, a neurophysiologist, a neuroradiologist and a functional neurosurgeon.

1.4 Further research should describe patient selection and define clearly the target area of the brain. Outcomes should include measures of seizure frequency, functional ability, social inclusion and quality of life.

  • National Institute for Health and Care Excellence (NICE)