Complete seizure freedom is possible in patients with MTLE-HS after surgery in spite of extratemporal electro-clinical features

Hippocampal deep brain stimulation in nonlesional refractory mesial temporal lobe epilepsy

“…Velasco et al have suggested that the perforant pathway activated by DBS might lead to a polysynaptic inhibition of epileptogenic neurons in hippocampal CA1-CA4 regions in charge of the initiation and/or propagation of temporal lobe epilepsy [25]. A more likely hypothesis that hippocampal structure as the hub in temporal lobe epileptogenic network is potentially involved in generation and/or propagation of epileptiform activity and stimulative current of DBS could inhibit ictal focus and propagation paths has been taken [26][27][28][29]. We endorsed this thesis that hippocampal DBS exert an inhibitory effect not only on ictal focus but also the epileptogenic network through local and remote modulation of network excitability.…”

Contralateral Hippocampal Stimulation for Failed Unilateral Anterior Temporal Lobectomy in Patients with Bilateral Temporal Lobe Epilepsy

“…Although there were no significant differences in seizure onset laterality on intracranial EEG (the proportion of seizures ipsilateral to the resection) between the patients with good (76%, range: 42-95%) or poor outcomes (78%, range: 50-97%; p = 0.68) [3], most of the reported patients with bilateral TLE and unilateral ATL present with over 70% seizure onset laterality, as in this study. The resection of the dominant epileptogenesis zone combined with the administration of postoperative AEDs can result in favorable seizure control [16]. Therefore, unilateral ATL is an efficient approach for seizure control in bilateral TLE, although this approach is more effective in patients with unilateral TLE [3,17,18,19].…”

Expert Opinion regarding Invasive Monitoring: From Surface to Depth

“…While planning the electrode implantation must be based on a solid presurgical hypothesis that takes into consideration a multitude of noninvasive tests, there are many factors that lead to variabilities across epileptologists in terms of what brain regions to sample and what types of electrodes to use. To take the value of seizure semiology as an example, seizures originating from the mesial temporal structures may manifest differently in different patients (1), while seizures originating from disparate cortical regions can manifest similarly (2). Another inconsistency is that some epileptologists implant areas where interictal epileptiform discharges (IEDs) are seen during noninvasive monitoring, while others do not.…”