Gamma Knife Radiosurgery of Paracentral Epilepsy

Abstract

Background: In pharmacoresistant focal epilepsies involving the central region, risk of motor deficit generally contraindicates cortical resection. Gamma knife radiosurgery (GK) is an established treatment for mesial temporal epilepsy and epilepsy associated with hypothalamic hamartoma. Objectives: To explore the safety profile and efficacy of GK in motor cortex epilepsies. Methods: Four patients (18-31 years) with intractable focal sensorimotor epilepsy seizures arising from the paracentral lobule, demonstrated by stereoelectroencephalography, in whom conventional surgery was contraindicated because of motor deficit risk underwent GK. A marginal dose of 24 Gy was delivered to a focal zone involving the paracentral lobule. Results Volume of treatment ranged from 1.6 to 3.18 cm³ (median: 2.34). No motor deficit or other adverse effect occurred. Follow-up was available for at least 3 years (range: 36-78 months; median: 49). No complication of GK, including motor deficit, occurred. Two patients achieved an Engel class 1B outcome and 2 were unchanged. Both of the patients who improved had gradual disappearance of objective motor ictal semiology (6-12 months after GK), preceding reduced seizure frequency (12-18 months onwards). Cerebral MRI showed no change. Conclusions: GK is a potentially useful treatment for focal paracentral epilepsies where conventional surgery would carry an unacceptable risk of motor deficit.

Gamma Knife radiosurgery for hypothalamic hamartoma preserves endocrine functions

“…GK is an effective treatment of hypothalamic hamartoma. [15][16][17][18] Up to now, however, few data were available on the potential endocrine side effects of such treatment. To our knowledge, only one study reported the endocrine outcome of patients treated by GK for hypothalamic hamartoma: Abla et al 19 reported no pituitary deficiency in 15 patients followed for 18-81 months, but did note the occurrence of transient poikilothermia in one, weight gain in 2, and anxiety and depression in 2 patients.…”

“…GK is an effective treatment of hypothalamic hamartoma . Up to now, however, few data were available on the potential endocrine side effects of such treatment.…”

Cardiac stereotactic body radiation therapy for ventricular tachycardia: Current experience and technical gaps

“…Especially relevant to cardiac SBRT is stereotactic radiosurgery (SRS) for temporal epilepsy, which involves the use of video-scalp-electroencephalogram and MRI to map seizure substrate. [20][21][22] This technique mirrors the multimodality approach to ablation that has become standard in the EP field. 21,22 Taken together, EP and radiation oncology share a history of multimodal therapy development which can naturally facilitate cross-disciplinary integration of diagnostic techniques heretofore specific to each field for cardiac SBRT.…”

“…[20][21][22] This technique mirrors the multimodality approach to ablation that has become standard in the EP field. 21,22 Taken together, EP and radiation oncology share a history of multimodal therapy development which can naturally facilitate cross-disciplinary integration of diagnostic techniques heretofore specific to each field for cardiac SBRT.…”

Non-REM-Parasomnie oder Frontallappenepilepsie – Warum sollte man genau hinschauen?

“…Antikonvulsiva sollten daher auch nach mehrjähriger Anfallsfreiheit weiter gegeben werden. Alternativen zur "klassischen" epilepsiechirurgischen Operation wie Gamma-Knife-Bestrahlung und Hochfrequenz-Thermokoagulation sind zurzeit Gegenstand der Forschung und können möglicherweise bei einem Teil der Patienten in Zukunft sinnvoll sein [63,64].…”