Long‐term amygdalohippocampal stimulation for refractory temporal lobe epilepsy

Vonck, Kristl; Boon, Paul; Achten, Erik; Reuck, Jacques De; Caemaert, Jacques

doi:10.1002/ana.10323

Cited by 280 publications

(195 citation statements)

References 20 publications

(21 reference statements)

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“…Recent studies have shown that brain stimulators placed within an epileptogenic zone in an attempt to control temporal focal seizures can reduce the occurrence of epileptiform discharges (Vonck et al, 2002;Yamamoto et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

Epileptiform synchronization in the rat insular and perirhinal cortices in vitro

Sudbury

Avoli

2007

Eur J of Neuroscience

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The hippocampus plays a primary role in temporal lobe epilepsy, a common form of partial epilepsy in adults. Recent studies, however, indicate that extrahippocampal areas such as the perirhinal and insular cortices represent important participants in this epileptic disorder. By employing field potential recordings in the in vitro 4‐aminopyridine model of temporal lobe epilepsy, we have investigated here the contribution of glutamatergic and GABAergic signaling to epileptiform activity in these structures. First, we provide evidence of epileptiform synchronicity between the perirhinal and insular cortices, and resolve some pharmacological and network mechanisms involved in sustaining the interictal‐ and ictal‐like discharges recorded there. Second, we report that in the absence of ionotropic glutamatergic transmission, GABAergic networks produce synchronous potentials that spread between the perirhinal and insular cortices. Finally, we have established that such activity is modulated by activating µ‐opioid receptors. Our findings support clinical and experimental evidence concerning the involvement of the perirhinal and insular cortex networks in temporal lobe epilepsy, and provide observations that may impact research focussing on the role of the insular cortex in nociception.

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Section: Discussionmentioning

confidence: 99%

Epileptiform synchronization in the rat insular and perirhinal cortices in vitro

Sudbury

Avoli

2007

Eur J of Neuroscience

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“…Over the last few years, several attempts have been made to use deep-brain electrical (Velasco et al, 2000a(Velasco et al, ,b, 2001Vonck et al, 2002;Yamamoto et al, 2002) or transcranial magnetic stimulation (Menkes and Gruenthal, 2000;Tergau et al, 1999) to abate seizures in patients presenting with epileptic disorders resistant to antiepileptic drugs, including mesial temporal lobe epilepsy (MTLE). These stimulating procedures have been often proved to be effective in reducing and/or abolishing both interictal and ictal discharges.…”

Section: Introductionmentioning

confidence: 99%

Repetitive low-frequency stimulation reduces epileptiform synchronization in limbic neuronal networks

D’Arcangelo

Panuccio

Tancredi

et al. 2005

Neurobiology of Disease

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Deep-brain electrical or transcranial magnetic stimulation may represent a therapeutic tool for controlling seizures in patients presenting with epileptic disorders resistant to antiepileptic drugs. In keeping with this clinical evidence, we have reported that repetitive electrical stimuli delivered at approximately 1 Hz in mouse hippocampus-entorhinal cortex (EC) slices depress the EC ability to generate ictal activity induced by the application of 4-aminopyridine (4AP) or Mg 2+ -free medium (Barbarosie, M., Avoli, M., 1997. CA3-driven hippocampalentorhinal loop controls rather than sustains in vitro limbic seizures. J. Neurosci. 17,[9308][9309][9310][9311][9312][9313][9314]. Here, we confirmed a similar control mechanism in rat brain slices analyzed with field potential recordings during 4AP (50 MM) treatment. In addition, we used intrinsic optical signal (IOS) recordings to quantify the intensity and spatial characteristics of this inhibitory influence. IOSs reflect the changes in light transmittance throughout the entire extent of the slice, and are thus reliable markers of limbic network epileptiform synchronization. First, we found that in the presence of 4AP, the IOS increases, induced by a train of electrical stimuli (10 Hz for 1 s) or by recurrent, single-shock stimulation delivered at 0.05 Hz in the deep EC layers, are reduced in intensity and area size by low-frequency (1 Hz), repetitive stimulation of the subiculum; these effects were observed in all limbic areas contained in the slice. Second, by testing the effects induced by repetitive subicular stimulation at 0.2-10 Hz, we identified maximal efficacy when repetitive stimuli are delivered at 1 Hz. Finally, we discovered that similar, but slightly less pronounced, inhibitory effects occur when repetitive stimuli at 1 Hz are delivered in the EC, suggesting that the reduction of IOSs seen during repetitive stimulation is pathway dependent as well as activity dependent. Thus, the activation of limbic networks at low frequency reduces the intensity and spatial extent of the IOS changes that accompany ictal synchronization in an in vitro slice preparation. This conclusion supports the view that repetitive stimulation may represent a potential therapeutic tool for controlling seizures in patients with pharmacoresistant epileptic disorders. D 2004 Elsevier Inc. All rights reserved.

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“…The effect of neuromodulation on deep brain nuclei 4,10,12,20,[36][37][38]43 exerts seizure control by anterograde or antidromic stimulation or inhibition of the cortex, 21 but no conclusive data on the ideal parameters for stimulation are known. The experience reported by Kahane et al 17 demonstrated seizure induction with frequency parameters ranging between 1 and 50 Hz.…”

Section: Discussionmentioning

confidence: 99%

Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma

Marras

Rizzi²,

Villani

et al. 2011

FOC

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Hypothalamic hamartomas (HHs) are developmental malformations associated with a range of neurological problems, including intractable seizures. There is increasing evidence of the epileptogenicity of the hamartoma and of the inhomogeneous distribution of the epileptic abnormalities within the malformation. The management strategy for treatment and results differ according to the insertion plane and the extension of the malformation into the hypothalamus. Cases characterized by extensive involvement of the hypothalamus are particularly challenging. The authors describe the case of a patient with drug-resistant epilepsy and a large hypothalamic hamartoma with an extensive area of attachment. The patient underwent implantation of 2 deep brain electrodes. The intraoperative recording showed a synchronous interictal epileptic discharge in the left temporal lobe and on the left side of the lesion. The patient was treated with chronic high-frequency stimulation. No side effects due to the stimulation were reported. At 18 months' follow-up, a reduction in complex partial seizure frequency was reported, but no significant reduction in overall seizure frequency was noticed (p = 0.14, t-test). The authors report on neurophysiological studies of the relationship between HH and epilepsy, and also discuss the literature on chronic high-frequency stimulation, including its rationale and the results of chronic stimulation of various targets for the treatment of drug-resistant epilepsy due to HH.

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Long‐term amygdalohippocampal stimulation for refractory temporal lobe epilepsy

Cited by 280 publications

References 20 publications

Epileptiform synchronization in the rat insular and perirhinal cortices in vitro

Epileptiform synchronization in the rat insular and perirhinal cortices in vitro

Repetitive low-frequency stimulation reduces epileptiform synchronization in limbic neuronal networks

Deep brain stimulation for the treatment of drug-refractory epilepsy in a patient with a hypothalamic hamartoma

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