Hippocampal deep brain stimulation in nonlesional refractory mesial temporal lobe epilepsy

Abstract

Chronic continuous hippocampal DBS demonstrated a potential efficiency and safety in nonlesional refractory mesial temporal lobe epilepsy and might represent an effective therapeutic option for these patients.

Deep brain stimulation for drug‐resistant epilepsy

“…Robust clinical trials demonstrate seizure frequency reductions of 40% following short-term ANT stimulation, 3 and 26%-40% following short-term HC stimulation, [34][35][36][37] in patients with primarily focal epilepsies. Pooled responder rates (seizure reduction ≥50%) were >70% for both ANT 9,18,19,[21][22][23][24][26][27][28][29][30][31][32][33] and HC-stimulated 13,14,[34][35][36][41][42][43][44][45][46][47] patients. Indeed, a recent meta-analysis found statistically significant reductions in seizure frequency secondary to ANT-DBS (high-quality evidence) and HC-DBS (moderate-quality evidence), but not for any other targets.…”

“…For instance, HC stimulation has been trialed empirically for temporal epilepsies, 13,14,[34][35][36][37][39][40][41][42][43][44][45][46][47] and CMT stimulation seems more effective for Lennox-Gastaut syndrome and in generalized seizures. For instance, HC stimulation has been trialed empirically for temporal epilepsies, 13,14,[34][35][36][37][39][40][41][42][43][44][45][46][47] and CMT stimulation seems more effective for Lennox-Gastaut syndrome and in generalized seizures.…”

“…4,10,16,17 Thus researchers have empirically trialed HC-DBS exclusively in patients with medial temporal lobe epilepsy (MTLE), some with magnetic resonance imaging (MRI) evidence of medial temporal (hippocampal) sclerosis. Current evidence includes 4 RCTs (one trialing RNS), [34][35][36][37][38] and 9 noncontrolled studies 13,14,[39][40][41][42][43][44][45][46][47] (Table 3).…”

Seizure outcome after hippocampal deep brain stimulation in patients with refractory temporal lobe epilepsy: A prospective, controlled, randomized, double‐blind study

“…Our previous open‐label study on hippocampal stimulation also suggested that unilateral or bilateral hippocampal stimulation was safe and effective in patients with TLE. These studies used a posterior approach for electrode insertion, since this method allows for sampling of larger portions of the hippocampus using a single electrode or “in tandem” electrodes …”

“…These studies used a posterior approach for electrode insertion, since this method allows for sampling of larger portions of the hippocampus using a single electrode or "in tandem" electrodes. [3][4][5][6][7][8][9] Further evaluation of the results of hippocampal stimulation through adequately designed randomized clinical trials are needed. We designed a prospective, randomized, controlled, double-blind study to evaluate the efficacy of hippocampal deep brain stimulation (Hip-DBS) in patients with refractory TLE (rTLE).…”