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

Abstract

Aims: To prospectively study the surgical outcomes of unilateral anterior temporal lobectomy (ATL) in patients with intractable bilateral temporal lobe epilepsy (TLE) as well as two-staged contralateral hippocampal stimulation in patients after failed unilateral ATL. Methods: Eighteen carefully selected patients with bilateral TLE underwent unilateral ATL. Five cases with failed ATL underwent two-staged contralateral hippocampal stimulation. Seizure control and changes in intelligence quotient (IQ), memory quotient, and quality of life (QOL) were analyzed 2-5 years after treatment. Results: In the patients with unilateral ATL, the percentages seizure free were 55.6% (10/18), 50.0% (9/18), and 44.4% (4/9) at the 1-, 2-, and 5-year follow-up visits, respectively. There were significant difference in seizure control between the patients with unilateral ATL and the 12 cases in the medication group. Significant differences were also found in changes in the patients' QOL and full-scale IQ at the 2-year follow-up between the surgical and medication groups. Five patients who underwent contralateral hippocampal stimulation after failed unilateral ATL experienced 80-100% seizure reductions, and 80% were seizure free 1 year after hippocampal stimulation. Conclusion: Unilateral ATL provides good seizure control and does not cause serious memory or IQ injury in carefully selected patients with true bilateral TLE. Contralateral hippocampal stimulation is a useful approach for patients who experience unilateral ATL failure.

A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood

“…Limitations of this study include the inclusion of only 1 randomized control trial, 7 5 blinded studies, 13,29,37,42,44 and 8 prospective trials, 9,13,19,26,29,37,[40][41][42]44 with the remaining 12 studies being retrospective case reports and case series. Furthermore, it is difficult to analyze and compare the effectiveness of DBS between studies, as different metrics and outcomes are reported.…”

“…24 Five patients had previous surgery in an attempt to treat their epilepsy. 2,5,9,20,37 The operations included a biopsy to identify a possible epileptogenic lesion, 2 a right precentral frontal lobe resection 5 and a left anterior temporal lobectomy 9 to attempt seizure reduction, and VNS; 37 1 patient had already undergone right fontal lobectomy, complete corpus callosotomy, VNS, left temporal lobectomy, and posterior quandrantectomy. 20 These procedures did not achieve the desired seizure reduction, and DBS was offered as an alternative treatment.…”

“…Five patients had DBS electrodes placed in the hippocampus. 7,9,41,42 Two of these patients with intractable temporal lobe seizures had bilateral depth and subdural electrodes implanted to determine the location and extent of the epileptic focus before a temporal lobectomy. 41 These electrodes only provided stimulation for 16 days, with seizure freedom in one patient and no change in the other.…”

Invasive Neuromodulation for the Treatment of Pediatric Epilepsy

“…Velasco et al [11] have demonstrated seizure frequency improvement in 9 children with Lennox-Gastaut after the insertion of bilateral CM electrodes. DBS has also been considered in children who have already undergone resective surgery without significant post-operative seizure reduction [14,24,25]. DBS has been used in four children who had a history of status epilepticus with an improvement in seizure frequency in three of these children [15,26].…”

Conduction treatment of temporal lobe epilepsy in rats: the dose-effect relationship between current resistance and therapeutic effect

“…Approximately 40% of patients experience continuous postoperative seizures after resective surgery (5,6). The percentage of postoperative seizure freedom is only 10% in patients who have undergone alleviation surgery or neuromodulation due to a nonlocalizable epileptogenic zone or an epileptogenic zone involving the eloquent area (7)(8)(9)(10). Therefore, it is necessary to explore novel treatments for drug-resistant epilepsy.…”