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Deep Brain Stimulation in Patients with Refractory Temporal Lobe Epilepsy

Paul Boon

Reference Center for Refractory Epilepsy (RCRE) and Laboratory for Clinical and Experimental Neurophysiology (LCEN)

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Kristl Vonck

Reference Center for Refractory Epilepsy (RCRE) and Laboratory for Clinical and Experimental Neurophysiology (LCEN)

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Veerle De Herdt

Reference Center for Refractory Epilepsy (RCRE) and Laboratory for Clinical and Experimental Neurophysiology (LCEN)

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Annelies Van Dycke

Reference Center for Refractory Epilepsy (RCRE) and Laboratory for Clinical and Experimental Neurophysiology (LCEN)

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Maarten Goethals

Reference Center for Refractory Epilepsy (RCRE) and Laboratory for Clinical and Experimental Neurophysiology (LCEN)

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Lut Goossens

Reference Center for Refractory Epilepsy (RCRE) and Laboratory for Clinical and Experimental Neurophysiology (LCEN)

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Michel Van Zandijcke

Reference Center for Refractory Epilepsy (RCRE) and Laboratory for Clinical and Experimental Neurophysiology (LCEN)

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Tim De Smedt

Reference Center for Refractory Epilepsy (RCRE) and Laboratory for Clinical and Experimental Neurophysiology (LCEN)

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Isabelle Dewaele

Reference Center for Refractory Epilepsy (RCRE) and Laboratory for Clinical and Experimental Neurophysiology (LCEN)

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Rik Achten

Department of Neurology; Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium

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Wytse Wadman

Swammerdam Institute for Life Sciences, Amsterdam University, Amsterdam, The Netherlands

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Frank Dewaele

Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium

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Jacques Caemaert

Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium

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Dirk Van Roost

Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium

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First published: 22 March 2007
Cited by: 191
Address correspondence and reprint requests to Dr. P. Boon at Reference Center for Refractory Epilepsy (RCRE), Laboratory for Clinical and Experimental Neurophysiology (LCEN), Department of Neurology, Ghent University Hospital, De Pintelaan 185, B‐9000 Gent, Belgium. E‐mail: Paul.Boon@UGent.be

Abstract

Summary: Purpose: This pilot study prospectively evaluated the efficacy of long‐term deep brain stimulation (DBS) in medial temporal lobe (MTL) structures in patients with MTL epilepsy.

Methods: Twelve consecutive patients with refractory MTL epilepsy were included in this study. The protocol included invasive video‐EEG monitoring for ictal‐onset localization and evaluation for subsequent stimulation of the ictal‐onset zone. Side effects and changes in seizure frequency were carefully monitored.

Results: Ten of 12 patients underwent long‐term MTL DBS. Two of 12 patients underwent selective amygdalohippocampectomy. After mean follow‐up of 31 months (range, 12–52 months), one of 10 stimulated patients are seizure free (>1 year), one of 10 patients had a >90% reduction in seizure frequency; five of 10 patients had a seizure‐frequency reduction of ≥50%; two of 10 patients had a seizure‐frequency reduction of 30–49%; and one of 10 patients was a nonresponder. None of the patients reported side effects. In one patient, MRI showed asymptomatic intracranial hemorrhages along the trajectory of the DBS electrodes. None of the patients showed changes in clinical neurological testing. Patients who underwent selective amygdalohippocampectomy are seizure‐free (>1 year), AEDs are unchanged, and no side effects have occurred.

Conclusions: This open pilot study demonstrates the potential efficacy of long‐term DBS in MTL structures that should now be further confirmed by multicenter randomized controlled trials.

Number of times cited: 191

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