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Kai J. Miller, Casey H. Halpern, Mark F. Sedrak, John A. Duncan III, and Gerald A. Grant

fiber-optic probes are used for laser ablation of the hippocampus and adjacent structures under MRI guidance (Visualase/Medtronic or Monteris). C: Recording/stimulating electrodes are placed stereotactically for responsive neurostimulation (Neuropace). Figure is available in color online only. Stereotactic targeting for these approaches is evolving, although it is currently prescribed for general anatomical structures rather than a landmark-based coordinate system. The present standard for directly targeting the amygdalohippocampal complex for SLAH is defined by

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Allen L. Ho, Anne-Mary N. Salib, Arjun V. Pendharkar, Eric S. Sussman, William J. Giardino, and Casey H. Halpern

responsive neurostimulation systems in the treatment of epilepsy has demonstrated the effectiveness of “closed-loop” recording and intermittent stimulation systems for the treatment of episodic electrical pathology within the brain. 45 Consumption-driven disorders of impulsivity may be ideal for this type of closed-loop treatment if stimulation could be delivered during brief windows of anticipation, or so-called moments of weakness prior to the initiation of a binge. 8 , 60 Wu et al. recently published a translational study validating this technique. They were able to

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Allen L. Ho, Yagmur Muftuoglu, Arjun V. Pendharkar, Eric S. Sussman, Brenda E. Porter, Casey H. Halpern, and Gerald A. Grant

obtained. Fourteen patients underwent or were offered a resective surgery, 2 patients underwent responsive neurostimulation (RNS), 2 patients have been offered RNS, and 1 patient had laser interstitial thermal therapy (LITT). There was an average postoperative follow-up of 7.92 months. In patients who underwent definitive epilepsy surgery with at least 3 months of follow-up (n = 12), 50% achieved an Engel class I result (seizure freedom), 25% had Engel class III (some seizure reduction), and 25% had Engel class IV (no improvement in seizures) ( Table 3 ). TABLE 3