title: Chronic deep brain stimulation in mesial temporal lobe epilepsy.
abstract: The objective of this study was to evaluate the efficiency and the effects of changes in parameters of chronic amygdala-hippocampal deep brain stimulation (AH-DBS) in mesial temporal lobe epilepsy (TLE). Eight pharmacoresistant patients, not candidates for ablative surgery, received chronic AH-DBS (130 Hz, follow-up 12-24 months): two patients with hippocampal sclerosis (HS) and six patients with non-lesional mesial TLE (NLES). The effects of stepwise increases in intensity (0-Off to 2 V) and stimulation configuration (quadripolar and bipolar), on seizure frequency and neuropsychological performance were studied. The two HS patients obtained a significant decrease (65-75%) in seizure frequency with high voltage bipolar DBS (≥1 V) or with quadripolar stimulation. Two out of six NLES patients became seizure-free, one of them without stimulation, suggesting a microlesional effect. Two NLES patients experienced reductions of seizure frequency (65-70%), whereas the remaining two showed no significant seizure reduction. Neuropsychological evaluations showed reversible memory impairments in two patients under strong stimulation only. AH-DBS showed long-term efficiency in most of the TLE patients. It is a valuable treatment option for patients who suffer from drug resistant epilepsy and who are not candidates for resective surgery. The effects of changes in the stimulation parameters suggest that a large zone of stimulation would be required in HS patients, while a limited zone of stimulation or even a microlesional effect could be sufficient in NLES patients, for whom the importance of the proximity of the electrode to the epileptogenic zone remains to be studied. Further studies are required to ascertain these latter observations.
authors.affiliation: Dpt Neurology, University Hospital of Geneva, 1211 Geneva 14, Switzerland. Colette.Boex@hcuge.ch
authors.forename: Colette
authors.initials: C
authors.lastname: Boëx
authors.forename: Margitta
authors.initials: M
authors.lastname: Seeck
authors.forename: Serge
authors.initials: S
authors.lastname: Vulliémoz
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
authors.forename: Claudio
authors.initials: C
authors.lastname: Staedler
authors.forename: Laurent
authors.initials: L
authors.lastname: Spinelli
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Pegna
authors.forename: Etienne
authors.initials: E
authors.lastname: Pralong
authors.forename: Jean-Guy
authors.initials: JG
authors.lastname: Villemure
authors.forename: Giovanni
authors.initials: G
authors.lastname: Foletti
authors.forename: Claudio
authors.initials: C
authors.lastname: Pollo
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000523:psychology; D004567:Electrodes, Implanted; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008134:Long-Term Care; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D012598:Sclerosis; D012640:Seizures / Q000453:epidemiology / Q000517:prevention & control; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants