Deep brain stimulation in patients with refractory temporal lobe epilepsy.
OBJECTIVE
This pilot study prospectively evaluated the efficacy of long-term deep brain stimulation (DBS) in medial temporal lobe (MTL) structures in patients with MTL epilepsy.


METHODS
Twelve consecutive patients with refractory MTL epilepsy were included in this study. The protocol included invasive video-EEG monitoring for ictal-onset localization and evaluation for subsequent stimulation of the ictal-onset zone. Side effects and changes in seizure frequency were carefully monitored.


RESULTS
Ten of 12 patients underwent long-term MTL DBS. Two of 12 patients underwent selective amygdalohippocampectomy. After mean follow-up of 31 months (range, 12-52 months), one of 10 stimulated patients are seizure free (>1 year), one of 10 patients had a >90% reduction in seizure frequency; five of 10 patients had a seizure-frequency reduction of > or =50%; two of 10 patients had a seizure-frequency reduction of 30-49%; and one of 10 patients was a nonresponder. None of the patients reported side effects. In one patient, MRI showed asymptomatic intracranial hemorrhages along the trajectory of the DBS electrodes. None of the patients showed changes in clinical neurological testing. Patients who underwent selective amygdalohippocampectomy are seizure-free (>1 year), AEDs are unchanged, and no side effects have occurred.


CONCLUSIONS
This open pilot study demonstrates the potential efficacy of long-term DBS in MTL structures that should now be further confirmed by multicenter randomized controlled trials.
Boon
Paul
P
Reference Center for Refractory Epilepsy, Laboratory for Clinical and Experimental Neurophysiology, Department of Neurology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. Paul.Boon@UGent.be
Vonck
Kristl
K
De Herdt
Veerle
V
Van Dycke
Annelies
A
Goethals
Maarten
M
Goossens
Lut
L
Van Zandijcke
Michel
M
De Smedt
Tim
T
Dewaele
Isabelle
I
Achten
Rik
R
Wadman
Wytse
W
Dewaele
Frank
F
Caemaert
Jacques
J
Van Roost
Dirk
D
D000679:Amygdala / Q000601:surgery; D000927:Anticonvulsants / Q000627:therapeutic use; D001931:Brain Mapping; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology; D046690:Deep Brain Stimulation / Q000379:methods*; D018572:Disease-Free Survival; D004567:Electrodes, Implanted / Q000009:adverse effects; D004569:Electroencephalography / Q000706:statistics & numerical data; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006624:Hippocampus / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008991:Monitoring, Physiologic; D010865:Pilot Projects; D011446:Prospective Studies; D013238:Stereotaxic Techniques; D013702:Temporal Lobe / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
D000927:Anticonvulsants