Long-term amygdalohippocampal stimulation for refractory temporal lobe epilepsy.
Short-term deep brain stimulation (DBS) recently has been shown to be efficacious in refractory temporal lobe epilepsy. We (1) evaluated long-term DBS in medial temporal lobe structures in patients with normal magnetic resonance imaging (MRI) findings and (2) investigated the use of chronic DBS electrodes for the localization of the ictal onset zone before DBS. In three patients with complex partial seizures (CPSs), DBS electrodes were implanted in the amygdalohippocampal region to identify and subsequently stimulate the ictal onset zone. CPSs were compared before and after chronic DBS. Side effects were carefully monitored. DBS electrodes yielded high-quality electroencephalogram recordings showing unilateral seizure onset in medial temporal lobe structures. For all patients, unilateral amygdalohippocampal stimulation was performed. After a mean follow-up of 5 months (range, 3-6 months), all patients had a greater than 50% reduction in seizure frequency. In two patients, antiepileptic drugs could be tapered. None of the patients reported side effects. This open study demonstrates the feasibility of consecutive electroencephalographic recordings and DBS in medial temporal lobe structures using DBS electrodes. These results prompt further studies in a larger patient population to establish the efficacy and safety of chronic DBS as an alternative treatment for refractory temporal lobe epilepsy.
Vonck
Kristl
K
Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. kristl.vonck@mri2.rug.ac.be
Boon
Paul
P
Achten
Erik
E
De Reuck
Jacques
J
Caemaert
Jacques
J
D000328:Adult; D000679:Amygdala / Q000503:physiopathology*; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D004599:Electric Stimulation Therapy; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000628:therapy*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006624:Hippocampus / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D012449:Safety; D013997:Time Factors; D016896:Treatment Outcome; D014743:Videotape Recording
D000927:Anticonvulsants