Forel-H-Tomy for the Treatment of Intractable Epilepsy

Jinnai, Dennosuke; Mukawa, Jiro; Kobayashi, Kazunobu

doi:10.1007/978-3-7091-8444-8_26

Cited by 6 publications

(18 citation statements)

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“…11 Jinnai et al reported the efficacy of Forel-H-tomy in 64 patients with intractable epilepsy. 5 In well-placed lesions (unilateral or bilateral), significant seizure reduction (diminished or abolished) was confirmed in generalized convulsions, focal convulsions, and the Lennox-Gastaut syndrome. Bilateral Forel-H-tomy was superior to unilateral Forel-H-tomy for seizure control.…”

Section: Discussionmentioning

confidence: 98%

“…Jelsma et al stated that the reduction of generalized seizures after Forel‐H‐tomy may be related to interruption of pallidothalamic pathways and thalamocortical circuits involving the irritable cortex, thus resulting in blockage of seizure dissemination 11 . Jinnai et al reported the efficacy of Forel‐H‐tomy in 64 patients with intractable epilepsy 5 . In well‐placed lesions (unilateral or bilateral), significant seizure reduction (diminished or abolished) was confirmed in generalized convulsions, focal convulsions, and the Lennox‐Gastaut syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…The rationales for Forel-H-tomy in treating epilepsy are interrupting the pathway of epileptic discharge (descending impulse) and elevating the seizure threshold based on experimental animal work. 5 Jelsma et al stated that the reduction of generalized seizures after Forel-H-tomy may be related to interruption of pallidothalamic pathways and thalamocortical circuits involving the irritable cortex, thus resulting in blockage of seizure dissemination. 11 Jinnai et al reported the efficacy of Forel-H-tomy in 64 patients with intractable epilepsy.…”

Section: Discussionmentioning

confidence: 99%

“…14 Complications reportedly associated with Forel-H-tomy include akinetic motor disturbances, speech difficulty, difficulty swallowing, and slight impairment in typing speed. 5,15 Jinnai et al stated that complications including motor, speech, and swallowing disturbances were confirmed only in cases when lesions were above the AC-PC plane, which were outside Forel's field H; therefore, precise ablation of Forel's field H was safe even in bilateral ablations. 5 However, in our experience, patients who underwent unilateral PTT for movement disorders developed mild hypophonia and dysarthria, as well as decreased hand dexterity.…”

Section: Discussionmentioning

confidence: 99%

“…In the 1960s and 1970s, stereotactic ablation of Forel's field H (Forel‐H‐tomy) was performed for the treatment of Parkinson's disease (PD) and cervical dystonia 3,4 . Almost simultaneously, Jinnai et al reported using Forel‐H‐tomy for treating epilepsy 5 . Although the ablation of Forel's field was forgotten for several decades, Jeanmonod's group revived Spiegel's Forel‐H‐tomy (renamed to “pallidothalamic tractotomy”) for the treatment of PD using radiofrequency and focused ultrasound ablation 6,7 …”

Section: Introductionmentioning

confidence: 99%

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Comorbid seizure reduction after pallidothalamic tractotomy for movement disorders: Revival of Jinnai’s Forel‐H‐tomy

Horisawa

Miyao

Hori³

et al. 2021

Epilepsia Open

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Forel‐H‐tomy for intractable epilepsy was introduced by Dennosuke Jinnai in the 1960s. Recently, Forel‐H‐tomy was renamed to “pallidothalamic tractotomy” and revived for the treatment of Parkinson's disease and dystonia. Two of our patients with movement disorders and comorbid epilepsy experienced significant seizure reduction after pallidothalamic tractotomy, demonstrating the efficacy of this method. The first was a 29‐year‐old woman who had temporal lobe epilepsy with focal impaired awareness seizure once every three months and an aura 10‐20 times daily, even with four antiseizure medicines. For the treatment of hand dyskinesia, she underwent left pallidothalamic tractotomy and her right‐hand dyskinesia significantly improved. Fourteen months later, she had experienced no focal impaired awareness seizure and the aura decreased to one to three times per month. The second case was that of a 15‐year‐old boy diagnosed with progressive myoclonic epilepsy, who developed generalized tonic‐clonic seizure, which manifested once every month, despite treatment with five antiseizure medicines. After surgery, myoclonic movements in his right hand slightly improved. A one‐year follow‐up revealed that he had not experienced a generalized tonic‐clonic seizure. The lesion locations in the two cases were close to the vicinity of Jinnai's Forel‐H‐tomy. Forel's field H deserves reconsideration as a treatment target for intractable epilepsy.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comorbid seizure reduction after pallidothalamic tractotomy for movement disorders: Revival of Jinnai’s Forel‐H‐tomy

Horisawa

Miyao

Hori³

et al. 2021

Epilepsia Open

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Mapping Lesion-Related Epilepsy to a Human Brain Network

et al. 2023

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ImportanceIt remains unclear why lesions in some locations cause epilepsy while others do not. Identifying the brain regions or networks associated with epilepsy by mapping these lesions could inform prognosis and guide interventions.ObjectiveTo assess whether lesion locations associated with epilepsy map to specific brain regions and networks.Design, Setting, and ParticipantsThis case-control study used lesion location and lesion network mapping to identify the brain regions and networks associated with epilepsy in a discovery data set of patients with poststroke epilepsy and control patients with stroke. Patients with stroke lesions and epilepsy (n = 76) or no epilepsy (n = 625) were included. Generalizability to other lesion types was assessed using 4 independent cohorts as validation data sets. The total numbers of patients across all datasets (both discovery and validation datasets) were 347 with epilepsy and 1126 without. Therapeutic relevance was assessed using deep brain stimulation sites that improve seizure control. Data were analyzed from September 2018 through December 2022. All shared patient data were analyzed and included; no patients were excluded.Main Outcomes and MeasuresEpilepsy or no epilepsy.ResultsLesion locations from 76 patients with poststroke epilepsy (39 [51%] male; mean [SD] age, 61.0 [14.6] years; mean [SD] follow-up, 6.7 [2.0] years) and 625 control patients with stroke (366 [59%] male; mean [SD] age, 62.0 [14.1] years; follow-up range, 3-12 months) were included in the discovery data set. Lesions associated with epilepsy occurred in multiple heterogenous locations spanning different lobes and vascular territories. However, these same lesion locations were part of a specific brain network defined by functional connectivity to the basal ganglia and cerebellum. Findings were validated in 4 independent cohorts including 772 patients with brain lesions (271 [35%] with epilepsy; 515 [67%] male; median [IQR] age, 60 [50-70] years; follow-up range, 3-35 years). Lesion connectivity to this brain network was associated with increased risk of epilepsy after stroke (odds ratio [OR], 2.82; 95% CI, 2.02-4.10; P &lt; .001) and across different lesion types (OR, 2.85; 95% CI, 2.23-3.69; P &lt; .001). Deep brain stimulation site connectivity to this same network was associated with improved seizure control (r, 0.63; P &lt; .001) in 30 patients with drug-resistant epilepsy (21 [70%] male; median [IQR] age, 39 [32-46] years; median [IQR] follow-up, 24 [16-30] months).Conclusions and RelevanceThe findings in this study indicate that lesion-related epilepsy mapped to a human brain network, which could help identify patients at risk of epilepsy after a brain lesion and guide brain stimulation therapies.

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Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

Horisawa

Kohara

Nonaka

et al. 2022

Ann Clin Transl Neurol

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Background Neurosurgical ablation of Forel's field H1 for cervical dystonia, which is currently abandoned, was formerly used in the 1960s–1970s. Regardless of the lack of neuroimaging modalities and objective evaluation scales, the reported efficacy was significant. Although recent studies have reappraised the ablation of the pallidothalamic tract at Forel's field H1 for Parkinson's disease, the efficacy for cervical dystonia has not been investigated well. Methods Data of 35 patients with cervical dystonia who underwent unilateral pallidothalamic tractotomy at Forel's field H1 were retrospectively analyzed. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores, the neck score of the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), and adverse events were evaluated preoperatively and at the last available follow‐up period. Results The mean clinical follow‐up period was 13.9 ± 6.5 months. The mean TWSTRS total scores were 34.3 ± 14.0 preoperatively and 18.4 ± 16.5 at the last available follow‐up period (46.4% improvement, p < 0.0001). The BFMDRS neck score also improved significantly from 6.2 ± 2.9 preoperatively to 2.8 ± 2.8 at the last available follow‐up period (55.0% improvement on the neck score, p < 0.0001). Reduced hand dexterity in seven patients, hypophonia in five patients, dysarthria in four patients, and executive dysfunction in one patient were confirmed as adverse events at the last available follow‐up evaluation. One patient had postoperative hemorrhage. Conclusion The current study confirmed significant improvement in TWSTRS total scores and BFMDRS neck scores at the 13.9‐month follow‐up after unilateral pallidothalamic tractotomy. The pallidothalamic tract in Forel's field H1 is expected to be an alternative treatment target for cervical dystonia.

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Forel-H-Tomy for the Treatment of Intractable Epilepsy

Cited by 6 publications

References 4 publications

Comorbid seizure reduction after pallidothalamic tractotomy for movement disorders: Revival of Jinnai’s Forel‐H‐tomy

Comorbid seizure reduction after pallidothalamic tractotomy for movement disorders: Revival of Jinnai’s Forel‐H‐tomy

Mapping Lesion-Related Epilepsy to a Human Brain Network

Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

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