{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:43:32Z","timestamp":1792417412344,"version":"4.4.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Drug-resistant bitemporal epilepsy presents a therapeutic challenge when resective surgery is not feasible due to bilateral seizure onset or eloquent cortex involvement. Neuromodulation has emerged as an alternative, with open-loop deep brain stimulation (DBS) and closed-loop responsive neurostimulation (RNS) as implantable strategies. Comparative indications for modality selection remain unclear. A narrative review of articles published from January 2007 to January 2026 was performed in PubMed\/MEDLINE. Approximately 120 articles were screened, and 39 studies were included. Due to heterogeneity in study design, findings were synthesized qualitatively. Both DBS and RNS significantly reduce seizure frequency in drug-resistant bitemporal epilepsy, with a median seizure reduction of approximately 60% to 75%. Seizure freedom, however, remained limited, reflecting the palliative nature of these treatments. Open-loop anterior nucleus of the thalamus (ANT) DBS provides network-level modulation with low maintenance, while hippocampal DBS offers localized temporal inhibition. Conversely, closed-loop RNS delivers adaptive focal stimulation via real-time sensing and yields chronic intracranial electroencephalogram data. While both modalities show comparable efficacy, RNS may be advantageous in focal or asymmetric bitemporal epilepsy. Cognitive outcomes were favorable for both techniques, with RNS demonstrating the prevention of memory and language decline. Both DBS and RNS are palliative neuromodulatory options for patients in whom resective surgery is not feasible. Treatment selection should be individualized based on seizure network characteristics, laterality, monitoring needs, participation capacity, and cognitive considerations. The primary goal is to reduce seizure frequency and improve quality of life rather than to achieve seizure freedom. Future multicenter studies and biomarker-driven strategies are needed to refine selection and improve long-term outcomes.<\/jats:p>","DOI":"10.4103\/aian.aian_226_26","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:00:37Z","timestamp":1791979237000},"page":"697-703","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Open-Loop Deep Brain Stimulation Versus Closed-Loop Responsive Neurostimulation in Drug-Resistant Bitemporal Epilepsy: A Narrative Review"],"prefix":"10.4103","volume":"29","author":[{"given":"Syeda Fatima","family":"Zehra","sequence":"first","affiliation":[{"name":"Department of Medicine, David Tvildiani Medical University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad A","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wah Medical College, Wah, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratiksha","family":"Baliga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Research, Mahatma Gandhi Mission Institute of Health Sciences, Panvel, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atif S","family":"Khatib","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faheem","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Medicine, Combined Military Hospital, Lahore Medical College and Institute of Dentistry, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"R1-20261019","doi-asserted-by":"crossref","first-page":"33","DOI":"10.14581\/jer.25004","article-title":"Deep brain stimulation therapy for drug-resistant epilepsy: Present and future perspectives","volume":"15","author":"Shon","year":"2025","journal-title":"J Epilepsy Res"},{"key":"R2-20261019","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.clinph.2023.07.007","article-title":"Characteristics of ictal thalamic EEG in pediatric-onset neocortical focal epilepsy","volume":"154","author":"Edmonds","year":"2023","journal-title":"Clin Neurophysiol"},{"key":"R3-20261019","doi-asserted-by":"crossref","first-page":"15357597251344166","DOI":"10.1177\/15357597251344166","article-title":"Epilepsy surgery in the last 10 years: Advancements and controversies","author":"Gonzalez-Martinez","year":"2025","journal-title":"Epilepsy Curr"},{"key":"R4-20261019","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.neuron.2013.01.020","article-title":"Probing and regulating dysfunctional circuits using deep brain stimulation","volume":"77","author":"Lozano","year":"2013","journal-title":"Neuron"},{"key":"R5-20261019","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.yebeh.2018.06.041","article-title":"Deep brain stimulation for epilepsy","volume":"88S","author":"Salanova","year":"2018","journal-title":"Epilepsy Behav"},{"key":"R6-20261019","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1038\/nrn2196","article-title":"Translational principles of deep brain stimulation","volume":"8","author":"Kringelbach","year":"2007","journal-title":"Nat Rev Neurosci"},{"key":"R7-20261019","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.expneurol.2013.04.004","article-title":"Neurostimulation in the treatment of epilepsy","volume":"244","author":"Bergey","year":"2013","journal-title":"Exp Neurol"},{"key":"R8-20261019","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.nbd.2009.09.022","article-title":"Network perspectives on the mechanisms of deep brain stimulation","volume":"38","author":"McIntyre","year":"2010","journal-title":"Neurobiol Dis"},{"key":"R9-20261019","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1212\/01.wnl.0000436078.95856.56","article-title":"Anterior nucleus of the thalamus: Functional organization and clinical implications","volume":"81","author":"Child","year":"2013","journal-title":"Neurology"},{"key":"R10-20261019","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1111\/j.1528-1167.2010.02536.x","article-title":"Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy","volume":"51","author":"Fisher","year":"2010","journal-title":"Epilepsia"},{"key":"R11-20261019","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1212\/WNL.0000000000001334","article-title":"Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy","volume":"84","author":"Salanova","year":"2015","journal-title":"Neurology"},{"key":"R12-20261019","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.seizure.2017.10.009","article-title":"Long-term follow-up of anterior thalamic deep brain stimulation in epilepsy: A 11-year, single center experience","volume":"52","author":"Kim","year":"2017","journal-title":"Seizure"},{"key":"R13-20261019","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1002\/epi4.70107","article-title":"Cognitive outcomes after deep brain stimulation in drug-resistant epilepsy: A comparison of anterior thalamic and hippocampal stimulation","volume":"10","author":"Kim","year":"2025","journal-title":"Epilepsia Open"},{"key":"R14-20261019","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.seizure.2016.12.014","article-title":"Memory and mood outcomes after anterior thalamic stimulation for refractory partial epilepsy","volume":"45","author":"Tr\u00f6ster","year":"2017","journal-title":"Seizure"},{"key":"R15-20261019","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.seizure.2013.08.005","article-title":"Seizure outcome after hippocampal deep brain stimulation in a prospective cohort of patients with refractory temporal lobe epilepsy","volume":"23","author":"Cukiert","year":"2014","journal-title":"Seizure"},{"key":"R16-20261019","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/978-3-211-33081-4_36","article-title":"The role of neuromodulation of the hippocampus in the treatment of intractable complex partial seizures of the temporal lobe","volume":"97","author":"Velasco","year":"2007","journal-title":"Acta Neurochir Suppl"},{"key":"R17-20261019","doi-asserted-by":"crossref","first-page":"256","DOI":"10.5603\/pjnns.98258","article-title":"Deep brain stimulation of anterior nucleus and centromedian nucleus of thalamus in treatment for drug-resistant epilepsy","volume":"58","author":"Sobstyl","year":"2024","journal-title":"Neurol Neurochir Pol"},{"key":"R18-20261019","doi-asserted-by":"crossref","first-page":"e197","DOI":"10.1111\/epi.18122","article-title":"Centromedian thalamic deep brain stimulation for idiopathic generalized epilepsy: Connectivity and target optimization","volume":"65","author":"Park","year":"2024","journal-title":"Epilepsia"},{"key":"R19-20261019","doi-asserted-by":"crossref","first-page":"1363128","DOI":"10.3389\/fnins.2024.1363128","article-title":"Personalized strategies of neurostimulation: From static biomarkers to dynamic closed-loop assessment of neural function","volume":"18","author":"Car\u00e8","year":"2024","journal-title":"Front Neurosci"},{"key":"R20-20261019","doi-asserted-by":"crossref","first-page":"294","DOI":"10.3390\/app16010294","article-title":"The therapeutic loop: closed-loop epilepsy systems mirroring the read-write architecture of brain-computer interfaces","volume":"16","author":"Montoya-G\u00e1lvez","year":"2026","journal-title":"Appl Sci"},{"key":"R21-20261019","doi-asserted-by":"crossref","first-page":"e1852","DOI":"10.1212\/WNL.0000000000206887","article-title":"Deep brain stimulation of the anterior nucleus of the thalamus in drug-resistant epilepsy in the MORE multicenter patient registry","volume":"100","author":"Peltola","year":"2023","journal-title":"Neurology"},{"key":"R22-20261019","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.3171\/2023.2.JNS222116","article-title":"Long-term outcomes after responsive neurostimulation for treatment of refractory epilepsy: A single-center experience of 100 cases","volume":"139","author":"Roa","year":"2023","journal-title":"J Neurosurg"},{"key":"R23-20261019","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.3390\/brainsci13121628","article-title":"A comparison of neuropsychological outcomes following responsive neurostimulation and anterior temporal lobectomy in drug-resistant epilepsy","volume":"13","author":"O'Donnell","year":"2023","journal-title":"Brain Sci"},{"key":"R24-20261019","doi-asserted-by":"crossref","first-page":"1240380","DOI":"10.3389\/fneur.2023.1240380","article-title":"Clinical outcomes following responsive neurostimulation implantation: A single center experience","volume":"14","author":"Owens","year":"2023","journal-title":"Front Neurol"},{"key":"R25-20261019","doi-asserted-by":"crossref","first-page":"2290","DOI":"10.1111\/epi.17331","article-title":"Anterior nucleus of the thalamus deep brain stimulation vs temporal lobe responsive neurostimulation for temporal lobe epilepsy","volume":"63","author":"Yang","year":"2022","journal-title":"Epilepsia"},{"key":"R26-20261019","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1159\/000549636","article-title":"Neuromodulation in refractory bitemporal lobe epilepsy in adults: A systematic review and meta-analysis","volume":"104","author":"Petersen","year":"2026","journal-title":"Stereotact Funct Neurosurg"},{"key":"R27-20261019","doi-asserted-by":"crossref","first-page":"1429223","DOI":"10.3389\/fnhum.2024.1429223","article-title":"The comparison of DBS and RNS for adult drug-resistant epilepsy: A systematic review and meta-analysis","volume":"18","author":"Li","year":"2024","journal-title":"Front Hum Neurosci"},{"issue":"Suppl 1","key":"R28-20261019","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1111\/epi.13686","article-title":"Deep brain stimulation targeting in refractory epilepsy","volume":"58","author":"Cukiert","year":"2017","journal-title":"Epilepsia"},{"key":"R29-20261019","doi-asserted-by":"crossref","first-page":"393","DOI":"10.5603\/pjnns.99150","article-title":"Deep brain stimulation of hippocampus in treatment of refractory temporal lobe epilepsy","volume":"58","author":"Sobstyl","year":"2024","journal-title":"Neurol Neurochir Pol"},{"key":"R30-20261019","doi-asserted-by":"crossref","first-page":"108992","DOI":"10.1016\/j.clineuro.2025.108992","article-title":"Deep brain stimulation for refractory epilepsy: A meta-analysis of stimulation parameters","volume":"256","author":"Vahedi","year":"2025","journal-title":"Clin Neurol Neurosurg"},{"key":"R31-20261019","doi-asserted-by":"crossref","first-page":"124","DOI":"10.25259\/SNI_911_2023","article-title":"Adequate control of seizures in a case of lead migration and neuromodulation of the posterior Sylvian junction: A case report","volume":"15","author":"Sandoval-Bonilla","year":"2024","journal-title":"Surg Neurol Int"},{"key":"R32-20261019","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1038\/s43856-023-00401-x","article-title":"Unearthing the mechanisms of responsive neurostimulation for epilepsy","volume":"3","author":"Rao","year":"2023","journal-title":"Commun Med (Lond)"},{"key":"R33-20261019","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1038\/s41551-025-01467-9","article-title":"Invasive neurophysiology and whole brain connectomics for neural decoding in patients with brain implants","volume":"10","author":"Merk","year":"2026","journal-title":"Nat Biomed Eng"},{"key":"R34-20261019","doi-asserted-by":"crossref","first-page":"117071","DOI":"10.1016\/j.bios.2024.117071","article-title":"A bimodal closed-loop neuromodulation implant integrated with ultraflexible probes to treat epilepsy","volume":"271","author":"Li","year":"2025","journal-title":"Biosens Bioelectron"},{"key":"R35-20261019","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1038\/s41593-025-01988-1","article-title":"Closed-loop electrical stimulation prevents focal epilepsy progression and long-term memory impairment","volume":"28","author":"Ferrero","year":"2025","journal-title":"Nat Neurosci"},{"key":"R36-20261019","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1055\/s-0045-1810600","article-title":"Innovations in epilepsy","volume":"11","author":"Ranganathan","year":"2025","journal-title":"Int J Epilepsy"},{"key":"R37-20261019","doi-asserted-by":"crossref","first-page":"1106511","DOI":"10.3389\/fneur.2023.1106511","article-title":"DBS of the ANT for refractory epilepsy: A single center experience of seizure reduction, side effects and neuropsychological outcomes","volume":"14","author":"Olaciregui Dague","year":"2023","journal-title":"Front Neurol"},{"key":"R38-20261019","first-page":"e68032","article-title":"Role of responsive neurostimulation in managing drug-resistant epilepsy: A systematic review of clinical outcomes","volume":"16","author":"Mushtaq","year":"2024","journal-title":"Cureus"}],"container-title":["Annals of Indian Academy of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aian.aian_226_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:04:11Z","timestamp":1792415051000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aian.aian_226_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aian.aian_226_26","relation":{},"ISSN":["0972-2327","1998-3549"],"issn-type":[{"value":"0972-2327","type":"print"},{"value":"1998-3549","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-02-25","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}