title: Seizure outcome after hippocampal deep brain stimulation in a prospective cohort of patients with refractory temporal lobe epilepsy.
abstract: OBJECTIVE
  In this study, we present the results obtained from a series of patients with refractory temporal lobe epilepsy (r-TLE) who underwent hippocampal deep brain stimulation (Hip-DBS).
  
  
  METHODS
  Nine consecutive adult patients were studied. Low-frequency and high-frequency stimulation was carried out immediately after the insertion of each electrode. Chronic continuous high-frequency stimulation was used during treatment. The mean follow-up time was 30.1 months. The mean age of the patients was 37.2 years. The MRI scan was normal in three patients; four patients had bilateral mesial temporal sclerosis (MTS), and two had unilateral MTS.
  
  
  RESULTS
  The patients with unilateral MTS received unilateral implantation and experienced a 76% and an 80% reduction in seizure frequency after Hip-DBS. All patients with normal MRI scans were implanted bilaterally. Two of these patients received unilateral activation of the electrodes and experienced a 97% and an 80% reduction in seizure frequency; the third patient had bilateral activation of the device and was a non-responder. All patients with bilateral MTS were implanted bilaterally. Three of these patients received unilateral activation of the device and experienced a 66%, a 66% and a 100% reduction in seizure frequency after Hip-DBS; one patient had bilateral electrode activation, and was a non-responder. Whenever present, generalised tonic-clonic seizures disappeared completely after Hip-DBS.
  
  
  CONCLUSIONS
  Although performed on a relatively small number of patients, Hip-DBS was safe and effective in our patients with r-TLE. Seven of the nine patients were considered responders. Hip-DBS might represent a useful therapeutic option in patients with refractory temporal lobe epilepsy who were not candidates for resective surgery or have had previous failed procedures.
authors.affiliation: Clinica de Epilepsia de Sao Paulo, Epilepsy Surgery Program, Sao Paulo, SP, Brazil. Electronic address: acukiert@uol.com.br.
authors.forename: Arthur
authors.initials: A
authors.lastname: Cukiert
authors.affiliation: Clinica de Epilepsia de Sao Paulo, Epilepsy Surgery Program, Sao Paulo, SP, Brazil.
authors.forename: Cristine Mella
authors.initials: CM
authors.lastname: Cukiert
authors.affiliation: Clinica de Epilepsia de Sao Paulo, Epilepsy Surgery Program, Sao Paulo, SP, Brazil.
authors.forename: Jose Augusto
authors.initials: JA
authors.lastname: Burattini
authors.affiliation: Clinica de Epilepsia de Sao Paulo, Epilepsy Surgery Program, Sao Paulo, SP, Brazil.
authors.forename: Alessandra Moura
authors.initials: AM
authors.lastname: Lima
mesh_terms: D000328:Adult; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000379:methods / Q000639:trends*; D004833:Epilepsy, Temporal Lobe / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006624:Hippocampus / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012640:Seizures / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Deep brain stimulation; Epilepsy; Outcome; Temporal lobe