Failure of low-dose radiosurgery to control temporal lobe epilepsy

Kawai, Kensuke; Suzuki, Ichirô; Kurita, Hiroki; Shin, Masahiro; Arai, Nobutaka; Kirino, Takaaki

doi:10.3171/jns.2001.95.5.0883

Cited by 55 publications

(53 citation statements)

References 14 publications

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“…On the other hand, in humans, seizure remission after RS of other epileptic lesions-hypothalamic hamartomas or vascular malformations-does not require radiologic changes consistent with radionecrosis. 33,34 Similarly, histopathology of hippocampal specimens obtained from open temporal lobectomy after failed RS for MTLE 1,3,7 demonstrates perivascular sclerosis and hyalinization, rather than necrosis. However, since these specimens were obtained from unsuccessful RS, they may not be sufficient to explain the changes required for successful RS in MTLE.…”

Section: Fluid-attenuated Inversion Recovery Coronal (A-e) T1 Coronamentioning

confidence: 99%

Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy

Chang

Quigg

et al. 2010

Neurology

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Section: Fluid-attenuated Inversion Recovery Coronal (A-e) T1 Coronamentioning

confidence: 99%

Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy

Chang

Quigg

et al. 2010

Neurology

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“…Previous studies have reported that a low radiation dose (< 20 Gy) is often associated with the failure of GKRS to control seizures and a lack of MRI changes 9 and that a higher dose causes greater clinical effects and radiological changes. 4 In our present study, we used the previously documented effective treatment dose of 24 Gy to the residual tissue of the presumed epileptogenic zone, although the target volume was lower than in previous studies (range 1.8-6.9 cm 3 vs 5.5-9 cm 3 ) that used GKRS as an initial surgical treatment in patients with MTLE-HS.…”

Section: Discussionmentioning

confidence: 99%

Gamma Knife radiosurgery for recurrent or residual seizures after anterior temporal lobectomy in mesial temporal lobe epilepsy patients with hippocampal sclerosis: long-term follow-up results of more than 4 years

Lee

Kang

Kim

et al. 2015

JNS

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M esial temporal lobe epilepsy (TLE) with hippocampal sclerosis (MTLE-HS) is one of the most important surgically amenable epilepsies for medically intractable epilepsy patients. 19,23 Long-term seizure freedom after temporal lobe resection has been reported to be approximately 65%. 8,21 Despite significant advances in the surgical procedure and the identification of surgical candidates, approximately 20%-30% of TLE patients continue to have seizures after conventional surgery. Moreover, the probability of seizure freedom 10 years after TLE surgery is reported to range between 40% and 50%. 11Several explanations have been proffered for these surgical failures, including incomplete resection of epileptogenic structures, generation or reactivation of new epileptogenic foci, a dual pathology, or, possibly, surgical ABBREVIATIONS AED = antiepileptic drug; ATL = anterior temporal lobectomy; ATL-AH = ATL with amygdalohippocampectomy; EEG = electroencephalography; GKRS = Gamma Knife radiosurgery; MTLE = mesial temporal lobe epilepsy; MTLE-HS = MTLE hippocampal sclerosis; TLE = temporal lobe epilepsy. SUBMITTED June 9, 2014. ACCEPTED December 18, 2014. INCLUDE WHEN CITING Published online July 10, 2015; DOI: 10.3171/2014.12.JNS141280. DISCLOSURE The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. They confirm that they have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. » This article has been updated from its originally published version to correct the affiliations. See the corresponding erratum notice; DOI: OBJECT Gamma Knife radiosurgery (GKRS) has proven efficacy in the treatment of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and is comparable to conventional resective surgery. It may be effective as an alternative treatment to reoperation after failed temporal lobe surgery in patients with MTLE-HS. The purpose of this study was to investigate the efficacy of GKRS in patients with unilateral MTLE-HS who did not achieve seizure control or had recurrent seizures after anterior temporal lobectomy (ATL). METHODS Twelve patients (8 males; mean age 35.50 ± 9.90 years) with MTLE-HS who underwent GKRS after failed ATL (Engel Classes III-IV) were included. GKRS targets included the remnant tissue or adjacent regions of the previously performed ATL with a marginal dose of 24-25 Gy at the 50% isodose line in all patients. Final seizure outcome was assessed using Engel's modified criteria during the final 2 years preceding data analysis. A comparison between signal changes on follow-up MRI and clinical outcome was performed. RESULTS All patients were followed up for at least 4 years with a mean duration of 6.18 ± 1.77 years (range 4-8.8 years) after GKRS. At the final assessment, 6 of 12 patients were classified as seizure free (Engel Class Ia, n = 3; Ic, n = 2; and Id, n = 1) and 6 patients were classified as not seiz...

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“…In other studies, resective surgery was also performed following GKRS because of insufficient treatment effect, and most patients became seizure-free immediately after open surgery. 3,13,25,30,36) Furthermore, delayed seizure control of GKRS exposes patients to many risks such as injury, drowning, or unexpected death associated with seizure. 22) Immediate cessation of seizure seems to decrease mortality after epilepsy surgery.…”

Section: Discussionmentioning

confidence: 99%

“…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. 22) In the studies with good seizure outcome, non-invasiveness and safety were emphasized as major advantages of GKRS over resective surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Kawamura

Onishi

Kohda

et al. 2012

Neurol. Med. Chir.(Tokyo)

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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.

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Failure of low-dose radiosurgery to control temporal lobe epilepsy

Cited by 55 publications

References 14 publications

Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy

Predictors of efficacy after stereotactic radiosurgery for medial temporal lobe epilepsy

Gamma Knife radiosurgery for recurrent or residual seizures after anterior temporal lobectomy in mesial temporal lobe epilepsy patients with hippocampal sclerosis: long-term follow-up results of more than 4 years

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

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