Optimizing deep brain stimulation for the treatment of drug-resistant temporal lobe epilepsy: a pilot study

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  • 1 Epilepsy Clinic and Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital “Dr. Eduardo Liceaga,” Mexico City; and
  • | 2 Programa de Doctorado en Ciencias Biomédicas, División de Estudios de Posgrado, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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OBJECTIVE

The authors sought to determine the antiseizure effects of deep brain stimulation (DBS) of the parahippocampal cortex (PHC) for treatment of drug-resistant mesial temporal lobe epilepsy (MTLE).

METHODS

After a 3-month baseline period, 6 adult patients with drug-resistant MTLE and hippocampal sclerosis (HS) had stereoelectroencephalography (SEEG)–DBS electrodes implanted at the PHC for identification of the seizure onset zone (SOZ). Patients entered an 8-month, randomized, double-blind protocol for DBS, followed by a 12-month open-phase study. Monthly reports of seizure frequency were collected, with separate counting of focal seizures with or without awareness impairment (focal impaired awareness seizures [FIAS] or focal aware seizures [FAS], respectively) and focal evolving to bilateral generalized tonic clonic seizures (GTCS). Stimulation parameters were 130 Hz, 450 μsec, 2.5–3 V, and cyclic stimulation 1 minute on/4 minutes off.

RESULTS

The total seizure rate decrement during follow-up was 41% (CI 25%–56%), with better seizure control for GTCS (IQR 19%–20%) and FIAS (IQR 0%–16%), with FAS being less responsive (IQR 67%–236%). No neuropsychological deterioration was observed.

CONCLUSIONS

PHC DBS induced important antiseizure effects in patients with incapacitating FIAS and GTCS, most likely through blocking the propagation of hippocampal-onset seizures. The PHC target can be easily and safely approached due to positioning away from vascular structures, and there was no evidence of DBS-induced cognitive deterioration.

ABBREVIATIONS

ATL = anterior temporal lobectomy; DBS = deep brain stimulation; FAS = focal aware seizures; FIAS = focal impaired awareness seizures; GTCS = generalized tonic clonic seizures; HS = hippocampal sclerosis; IED = interictal epileptiform discharge; MTLE = mesial temporal lobe epilepsy; PHC = parahippocampal cortex; QOLIE-89 = Quality of Life Epilepsy Inventory; SAHCS = subacute hippocampal stimulation; SEEG = stereo electroencephalography; SOZ = seizure onset zone; 18F-FDG = 2-18F-fluoro-2-deoxy-d-glucose; 18F-FFMZ = 2′-18F-fluoro-flumazenil.

Schematics of transseptal interforniceal resection of a superiorly recessed colloid cyst. ©Mark Souweidane, published with permission. See the article by Tosi et al. (pp 813–819).

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