Absolute and Relative Predictor Values of Some Non-Invasive and Invasive Studies for the Outcome of Anterior Temporal Lobectomy

Velasco, Ana Luisa; Boleaga, Bernardo; Brito, Francisco; Jiménez, Fiacro; Gordillo, José Luís; Velasco, Francisco; Velasco, Marcos

doi:10.1016/s0188-0128(99)00050-0

Cited by 27 publications

(25 citation statements)

References 12 publications

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“…Further demographic details of the patient group are shown in Table 1; further details of the criteria for patient selection for electrode implantation and temporal lobectomy are reported elsewhere (19).…”

Section: Methodsmentioning

confidence: 99%

“…In our experience (19), temporal lobectomies that include the hippocampus but spare the amygdala and a good portion of the temporal cortex have been very successful in eliminating or reducing the number of temporal lobe seizures. However, the general consensus (14) is that temporal lobectomies are not advisable for patients with bilateral temporal foci or a unilateral focus spreading to surrounding cerebral regions of the dominant hemisphere because both bilateral conventional and unilateral extensive temporal lobectomies produce devastating effects on brain functions, particularly on language and memory.…”

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confidence: 94%

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Subacute Electrical Stimulation of the Hippocampus Blocks Intractable Temporal Lobe Seizures and Paroxysmal EEG Activities

Velasco

Velasco²,

Velasco³

et al. 2000

Epilepsia

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264

172

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Summary:Purpose: To investigate the clinical, electroencephalographic (EEG), and histopathologic effects of subacute electrical stimulation of the hippocampal formation or gyrus (SAHCS) on 10 patients with intractable temporal lobe seizures.Methods: Bilateral, depth, hippocampal or unilateral, subdural, basotemporal electrodes were implanted in all 10 patients for a topographic diagnosis of the site and extent of the epileptic focus before a temporal lobectomy. In all patients, antiepileptic drugs (AEDs) were discontinued from 48 to 72 h before a program of continuous SAHCS, which was performed for 2-3 weeks. Stimulation parameters were biphasic Lilly wave pulses, 1301s in frequency, 450 p. s in duration, and 200-400 p,A in amplitude. The stimuli were delivered 23 of every 24 h for the 2-3-week SAHCS period. The effects of SAHCS on the number of clinical seizures per day and the percentage of interictal EEG spikes per 10-second samples of maximal paroxysmal activity at the epileptic focus were determined daily during the 16 days of SAHCS. At the completion of this program, patients underwent an en bloc temporal lobectomy, and the histopathologic effects of SAHCS on the stimulated tissue were analyzed by means of light-microscopy studies.Results: In seven patients whose stimulation electrode contacts were placed within the hippocampal formation or gyrus and who experienced no interruption in the stimulation pro- creased the number of interictal EEG spikes at the focus after 5-6 days. The most evident and fast responses were found by stimulating either the anterior pes hippocampus close to the amygdala or the anterior parahippocampal gyrus close to the entorhinal cortex. Other surface, hippocampal, and basotemporal EEG signs predicted and accompanied this antiepileptic response. These included an electropositive DC shift and monomorphic delta activity at the medial hippocampal and parahippocampal regions, and a normalization of the background EEG activity and signs of slow-wave sleep in surface, depth, and subdural regions. In contrast, no evident antiepileptic responses or no responses at all were found in three patients when stimulation was either interrupted or when it was adniinistered outside the hippocampus.Light microscopy analysis of the stimulated hippocampal tissue showed histopathological abnormalities attributable to the depth-electrode penetration damage or to the pial surface reaction to the subdural, Silastic electrode plate. However, no evident histopathological differences were found between the stimulated and nonstimulated hippocampal tissue.Conclusions: SAHCS appears to be a safe procedure that can suppress temporal lobe epileptogenesis with no additional damage to the stimulated tissue.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 94%

Subacute Electrical Stimulation of the Hippocampus Blocks Intractable Temporal Lobe Seizures and Paroxysmal EEG Activities

Velasco

Velasco²,

Velasco³

et al. 2000

Epilepsia

Self Cite

264

172

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“…Select patients with MTL epilepsy who do not respond to medical therapy are considered candidates for amygdalohippocampectomy. Multiple groups have reported excellent results (significant seizure reduction in 80%-90% of patients) 74 with this procedure. On the other hand, those with bilateral onset of seizures or with a unilateral focus that spreads to the dominant hemisphere have not traditionally been surgical candidates due to the potential risk to language and memory areas associated with bilateral resections or large dominant lobe resections.…”

Section: Hippocampusmentioning

confidence: 97%

“…64 A subset of these patients will be candidates for ATL, which in reported series has resulted in 80%-90% seizure freedom. 74 For the remaining patients, alternative therapies such as VNS, 20 lesionectomy, and multiple subpial transections have proven limited in efficacy. Given the tremendous success of DBS for the treatment of movement and neuropsychiatric disorders, 53,62 clinicians have begun to explore the potential of electrical stimulation for the treatment of a select group of patients with medication-refractory epilepsy.…”

mentioning

confidence: 99%

Disrupting abnormal electrical activity with deep brain stimulation: is epilepsy the next frontier?

Rahman

Abd-El-Barr²,

Vedam‐Mai³

et al. 2010

FOC

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Given the tremendous success of deep brain stimulation (DBS) for the treatment of movement and neuropsychiatric disorders, clinicians have begun to open up to the possible use of electrical stimulation for the treatment of patients with uncontrolled seizures. This process has resulted in the discovery of a wide array of DBS targets, including the cerebellum, hypothalamus, hippocampus, basal ganglia, and various thalamic nuclei. Despite the ambiguity of the mechanism of action and the unknowns surrounding potentially ideal stimulation settings, several recent trials have empirically demonstrated reasonable efficacy in selected cases of medication-refractory seizures. These exciting results have fueled a number of studies aimed at firmly establishing DBS as an effective treatment for selected cases of intractable epilepsy, and many companies are aiming at Food and Drug Administration approval. We endeavor to review the studies in the context of the various DBS targets and their relevant circuitry for epilepsy. Based on the unfolding research, DBS has the potential to play an important role in treating refractory epilepsy. The challenge, as in movement disorders, is to assemble interdisciplinary teams to screen, implant, and follow patients, and to clarify patient selection. The future will undoubtedly be filled with optimization of targets and stimulation parameters and the development of best practices. With tailored therapeutic approaches, epilepsy patients have the potential to improve with DBS.

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“…Studies suggested that the GABA A receptor might be involved in the effect of hippocampal stimulation [18][19][20][21]. Recent publications have considered that the mechanism of hippocampal stimulation may be related to the extrasynaptic expression level of the GABA A receptor α5 subunit [22].…”

mentioning

confidence: 99%

Hippocampal Low-Frequency Stimulation Decreased cAMP Response Element-Binding Protein and Increased GABAA Receptor Subunit α1 in Amygdala-Kindled Pharmacoresistant Epileptic Rats

Wu¹,

Wang²,

Zhou³

et al. 2017

Neuropsychiatry

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Aim: To observe the changes in cAMP response element-binding protein (CREB) and GABA A receptor subunit α1 in amygdala-kindled pharmacoresistant epileptic rats subjected to hippocampal low-frequency stimulation (Hip-LFS). Methods:A total of sixteen pharmacoresistant epileptic rats were selected from fifty rats with amygdalakindled epilepsy by testing their seizure response to phenytoin (PHT) and phenobarbital (PB). The pharmacoresistant epileptic rats were assigned to a pharmacoresistant control group (PRC group) or a pharmacoresistant stimulation group (PRS group), each of which included 8 rats. The same number of pharmacosensitive epileptic rats was assigned to a pharmacosensitive control group (PSC group, 8 rats). A normal rat control (NRC) group of 8 rats was also used in the study. A stimulation electrode was implanted in the hippocampus of each rat from each of the four groups. Hip-LFS was administered to the PRS group twice per day for 2 weeks. The other three groups only received hippocampal sham stimulation. Following 2 weeks of Hip-LFS, seizure degree and amygdala EEG were recorded. The levels of CREB protein and GABA A receptor subunit α1 in the hippocampal tissues were measured by a Western blot. Results:The CREB level increased remarkably and the GABA A receptor subunit α1 level decreased in the pharmacoresistant epileptic rats compared with the control. Following two weeks of Hip-LFS, stimulation-induced seizures and amygdala EEG were inhibited significantly. The CREB and p-CREB level decreased significantly in the PRS group compared with the PRC group. However, the GABA A α1 subunit level in the PRS group increased dramatically compared with that in the PRC group. Conclusions:Hip-LFS might increase the expression of the GABA A α1 subunit and decrease the level of CREB. The Hip-LFS-induced increase in the level of the GABA A receptor α1 subunit might be associated with the decreases in CREB and p-CREB in the treatment of amygdala-kindled pharmacoresistant epileptic rats.

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Absolute and Relative Predictor Values of Some Non-Invasive and Invasive Studies for the Outcome of Anterior Temporal Lobectomy

Cited by 27 publications

References 12 publications

Subacute Electrical Stimulation of the Hippocampus Blocks Intractable Temporal Lobe Seizures and Paroxysmal EEG Activities

Subacute Electrical Stimulation of the Hippocampus Blocks Intractable Temporal Lobe Seizures and Paroxysmal EEG Activities

Disrupting abnormal electrical activity with deep brain stimulation: is epilepsy the next frontier?

Hippocampal Low-Frequency Stimulation Decreased cAMP Response Element-Binding Protein and Increased GABAA Receptor Subunit α1 in Amygdala-Kindled Pharmacoresistant Epileptic Rats

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