A multicenter, prospective pilot study of gamma knife radiosurgery for mesial temporal lobe epilepsy: Seizure response, adverse events, and verbal memory

Barbaro, Nicholas M.; Quigg, Mark; Broshek, Donna K.; Ward, Mariann M.; Lamborn, Kathleen R.; Laxer, Kenneth D.; Larson, David A.; Dillon, William; Verhey, Lynn; Garcia, Paul A.; Steiner, Ladislau; Heck, Christine; Kondziolka, Douglas; Beach, Robert L.; Olivero, William C.; Witt, Thomas C.; Salanova, Vicenta; Goodman, Robert

doi:10.1002/ana.21558

Cited by 162 publications

(209 citation statements)

References 56 publications

Supporting

Mentioning

201

Contrasting

Order By: Relevance

“…3) Delay in seizure control after GKRS for MTLE has been well documented. [2][3][4]11,24) Significant reduction in seizures usually occurred at least 1 year after GKRS. Delayed treatment response makes evaluation of the treatment effectiveness difficult, because some patients might undergo open surgery before seizure control by GKRS.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment for medically unmanageable intracranial hypertension caused by DRN was also reported. 2,8) Significant risk factors for DRN are treatment volume and radiation dose. Increase in dose and/or target volume enhances the risk of acute radiation effect and DRN.…”

Section: Discussionmentioning

confidence: 99%

“…3,24) Another pilot study reported that 67% of patients with MTLE were seizure-free after GKRS using 20 or 24 Gy at the 36-month followup evaluation. 2) However, some studies reported that none of the patients became seizure-free after GKRS. 13,30,36) To date, the seizure outcome in patients with MTLE after GKRS has not been consistent.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

Kawamura

Onishi

Kohda

et al. 2012

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

Gamma knife radiosurgery (GKRS) for mesial temporal lobe epilepsy (MTLE) has been proposed as an alternative to surgical resection. We report serious adverse effects of the treatment after follow-up periods over 9 years in 11 patients treated with GKRS between 1997 and 2000. The target volume of the entorhinoamygdalohippocampectomy area was 4.8-17.1 ml. Marginal dose of 20-25 Gy to the 50% isodose was delivered. One patient was drowned after suffering seizure 7 months after GKRS. Two patients did not show any reduction in seizure frequency over 9 and 18 months. Both patients requested open surgery and became seizure-free postoperatively. Four of the other eight patients were classified as Engel's class I within 4 years after GKRS. One of the four patients experienced symptomatic radiation-induced cerebral edema transiently, one developed radiation necrosis and required surgery 5 years after GKRS, and one developed cognitive impairment with hemiparesis 10 years after GKRS. Magnetic resonance (MR) imaging showed a large cyst in the irradiated temporal lobe. This patient recovered fully after the cyst excision. Only one patient became seizure-free and antiepileptic drug-free without symptomatic radiation-induced complications. However, MR imaging revealed abnormal enhancement, cyst formation, and diffuse white matter change in the irradiated temporal lobe 9 years after GKRS. GKRS for MTLE causes adverse effects of delayed seizure remission and symptomatic radiationinduced complications. Therefore, GKRS cannot be considered as an ideal alternative to surgery for MTLE. Long-term follow-up studies including MR imaging with contrast medium are required for the patients even after successful control of seizures.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

Kawamura

Onishi

Kohda

et al. 2012

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

show abstract

“…The RCT of RS20 reported seizure freedom in 76.9% (high dose) and 58.5% (low dose) of patients at 3 years. Neuropsychological outcomes were available on 26 patients at 2 years and were no different than at baseline.…”

Section: The Evidence For Palliative and Ablative Proceduresmentioning

confidence: 99%

“…Resective epilepsy surgery, in appropriately selected patients, is the accepted treatment of choice for DRE as supported by two randomized clinical trials,3, 4 multiple retrospective cohort series, and a practice parameter issued by the American Academy of Neurology recommending a surgical evaluation for any patient with uncontrolled disabling complex partial seizures 5. Similarly, a plethora of nonresective yet surgical DRE treatments have flourished recently, including various neuromodulation procedures6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 and thermal‐based19 and radiation‐based neurosurgeries 20. A position statement by the Practice Management Committee Health Care Reform Workgroup of the American Epilepsy Society called for access and insurance coverage for all patients with epilepsy for more aggressive therapeutic strategies, including neurosurgery and implanted electronic devices, when medications fail to yield optimal seizure control 21.…”

mentioning

confidence: 99%

Not all that glitters is gold: A guide to surgical trials in epilepsy

Jehi

2016

Epilepsia Open

View full text Add to dashboard Cite

SummaryEpilepsy surgery is often the only effective treatment in appropriately selected patients with drug‐resistant epilepsy, a disease affecting about 30% of those with epilepsy. We review the evidence supporting the use of epilepsy surgery, with a focus on randomized controlled trials (RCTs). Second, we identify gaps in knowledge about the benefits of epilepsy surgery for certain populations, the challenges of individualizing the choice of surgery, and our lack of understanding of the mechanisms of surgical outcomes. We conducted a search (MEDLINE, Embase, Cochrane, Clinicaltrials.gov) on March 2, 2016, to identify epilepsy surgery RCTs, systematic reviews, or health technology assessments (HTAs). Abstracts were screened to identify resective, palliative (e.g., corpus callosotomy, multiple subpial transection [MST]), ablative (e.g., Laser interstitial thermal therapy [LITT], gamma knife radiosurgery [RS]), and neuromodulation (e.g., cerebellar stimulation [CS], hippocampal stimulation [HS], repetitive transcranial magnetic stimulation [rTMS], responsive neurostimulation [RNS], thalamic stimulation [TS], trigeminal nerve stimulation [TNS], and vagal nerve stimulation [VNS]) RCTs. Study characteristics and outcomes were extracted. Knowledge gaps were identified. Of 1,205 abstracts, 20 RCTs were identified (resective surgery including corpus callosotomy [n = 7], MST [n = 0], RS [n = 1, 3 papers], LITT [n = 0], CS [n = 1], HS [n = 2], RNS [n = 1], rTMS [n = 1], TNS [n = 1], TS [n = 1], and VNS [n = 5]). Most studies targeted patients with temporal lobe epilepsy (TLE) and none examined the effectiveness of resective surgical therapies in patients with extra‐TLE (ETLE) or with specific lesions aside from mesial temporal lobe sclerosis. No pediatric surgical RCTs were identified except for VNS. Few RCTs address the effectiveness of surgery in epilepsy and most are of limited generalizability. Future studies are needed to compare the effectiveness of different surgical strategies, better understand the mechanisms of surgical outcomes, and define the ideal surgical approaches, particularly for patients with high or very low cognitive function, normal imaging, or ETLE.

show abstract