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Alternative Surgical Approaches in Epilepsy

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Abstract

The mainstay of epilepsy surgery is the resection of a presumed seizure focus or disruption of seizure propagation pathways. These approaches cannot be applied to all patients with medically refractory epilepsy (MRE). Since 1997, vagus nerve stimulation has been a palliative adjunct to the care of MRE patients. Deep brain stimulation (DBS) in select locations has been reported to reduce seizure frequency in small studies over the past three decades. Recently published results from the SANTE (Stimulation of the Anterior Nuclei of Thalamus for Epilepsy) trial—the first large-scale, randomized, double-blind trial of bilateral anterior thalamus DBS for MRE—demonstrate a significant reduction in seizure frequency with programmed stimulation. Another surgical alternative is the RNS™ System (NeuroPace, Mountain View, CA), which uses a closed-loop system termed responsive neurostimulation to both detect apparent seizure onsets and deliver stimulation. Recently presented results from the RNS™ pivotal trial demonstrate a sustained reduction in seizure frequency with stimulation, although comprehensive trial results are pending.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Devinsky O. Patients with refractory seizures. N Engl J Med. 1999;340:1565–70.

    Article  PubMed  CAS  Google Scholar 

  2. McLachlan RS. A brief review of the anatomy and physiology of the limbic system. Can J Neurol Sci. 2009;36 Suppl 2:S84–7.

    PubMed  Google Scholar 

  3. Lega BC, Halpern CH, Jaggi JL, Baltuch GH. Deep brain stimulation in the treatment of refractory epilepsy: update on current data and future directions. Neurobiol Dis. 2010;38:354–60.

    Article  PubMed  Google Scholar 

  4. •• Fisher R, Salanova V, Witt T, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia. 2010;51:899–908. This is the first large-scale, randomized controlled trial of DBS for epilepsy. The design of the trial reflects other major epilepsy trials, and its results demonstrate a statistically significant benefit in seizure reduction with stimulation.

    Article  PubMed  Google Scholar 

  5. Cooper IS, Upton AR, Amin I. Reversibility of chronic neurologic deficits. Some effects of electrical stimulation of the thalamus and internal capsule in man. Appl Neurophysiol. 1980;43:244–58.

    PubMed  CAS  Google Scholar 

  6. Upton AR, Amin I, Garnett S, et al. Evoked metabolic responses in the limbic-striate system produced by stimulation of anterior thalamic nucleus in man. Pacing Clin Electrophysiol. 1987;10:217–25.

    Article  PubMed  CAS  Google Scholar 

  7. Cooper IS, Upton AR, Amin I, et al. Evoked metabolic responses in the limbic-striate system produced by stimulation of anterior thalamic nucleus in man. Int J Neurol. 1984;18:179–87.

    PubMed  CAS  Google Scholar 

  8. Hodaie M, Wennberg RA, Dostrovsky JO, Lozano AM. Chronic anterior thalamus stimulation for intractable epilepsy. Epilepsia. 2002;43:603–8.

    Article  PubMed  Google Scholar 

  9. Kerrigan JF, Litt B, Fisher RS, et al. Electrical stimulation of the anterior nucleus of the thalamus for the treatment of intractable epilepsy. Epilepsia. 2004;45:346–54.

    Article  PubMed  Google Scholar 

  10. Lee KJ, Jang KS, Shon YM. Chronic deep brain stimulation of subthalamic and anterior thalamic nuclei for controlling refractory partial epilepsy. Acta Neurochir Suppl. 2006;99:87–91.

    Article  PubMed  CAS  Google Scholar 

  11. Lim SN, Lee ST, Tsai YT, et al. Electrical stimulation of the anterior nucleus of the thalamus for intractable epilepsy: a long-term follow-up study. Epilepsia. 2007;48:342–7.

    Article  PubMed  Google Scholar 

  12. Osorio I, Overman J, Giftakis J, Wilkinson SB. High frequency thalamic stimulation for inoperable mesial temporal epilepsy. Epilepsia. 2007;48:1561–71.

    Article  PubMed  Google Scholar 

  13. Neurological Devices Panel Meeting. Food and Drug Administration, March 2010. (Accessed at http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/NeurologicalDevicesPanel/UCM206524.pdf.)

  14. Fisher RS, Uematsu S, Krauss GL, et al. Placebo-controlled pilot study of centromedian thalamic stimulation in treatment of intractable seizures. Epilepsia. 1992;33:841–51.

    Article  PubMed  CAS  Google Scholar 

  15. Wright GD, McLellan DL, Brice JG. A double-blind trial of chronic cerebellar stimulation in twelve patients with severe epilepsy. J Neurol Neurosurg Psychiatry. 1984;47:769–74.

    Article  PubMed  CAS  Google Scholar 

  16. Velasco M, Velasco F, Velasco AL, et al. Subacute electrical stimulation of the hippocampus blocks intractable temporal lobe seizures and paroxysmal EEG activities. Epilepsia. 2000;41:158–69.

    Article  PubMed  CAS  Google Scholar 

  17. Tellez-Zenteno JF, McLachlan RS, Parrent A, et al. Hippocampal electrical stimulation in mesial temporal lobe epilepsy. Neurology. 2006;66:1490–4.

    Article  PubMed  CAS  Google Scholar 

  18. Controlled Randomized Stimulation Versus Resection (CoRaStiR). U.S. National Institutes of Health. (Accessed April 21, 2011, at http://clinicaltrials.gov/ct2/show/NCT00431457.)

  19. A Multicenter Study of Hippocampal Electrical Stimulation. U.S. National Institutes of Health. (Accessed April 21, 2011, at http://clinicaltrials.gov/ct2/show/NCT00717431.)

  20. Vossler D, Doherty M, Goodman R, et al. Early safety experience with a fully implanted intracranial responsive neurostimulator for epilepsy. In: 58th Annual Meeting of the American Epilepsy Society Meeting. New Orleans, Louisiana; Dec 3–7, 2004.

  21. Kossoff EH, Ritzl EK, Politsky JM, et al. Effect of an external responsive neurostimulator on seizures and electrographic discharges during subdural electrode monitoring. Epilepsia. 2004;45:1560–7.

    Article  PubMed  Google Scholar 

  22. Sun FT, Morrell MJ, Wharen Jr RE. Responsive cortical stimulation for the treatment of epilepsy. Neurotherapeutics. 2008;5:68–74.

    Article  PubMed  Google Scholar 

  23. Morrell MJ, RNS System Pivotal Investigators: Results of a multicenter double blinded randomized controlled pivotal investigation of the RNS(TM) system for treatment of intractable partial epilepsy in adults. In: Presented at the 63rd Annual American Epilepsy Society Meeting. Boston, MA; Dec 4–8, 2009.

  24. • C Heck RSPI. Long Term Follow-up fo the RNS (TM) System in Adults with Medically Intractable Partial Onset Seizures. In: 64th Annual American Epilepsy Society Meeting. San Antonio, TX; Dec 3–7, 2010. The preliminary results of the RNS™ pivotal trial were presented by the investigators at the AES meeting. Although complete trial results are not published in the abstract, more comprehensive data were presented at the meeting. The complete results, including seizure frequency reduction, seizure freedom, and adverse events, are pending publication.

  25. Engel Jr J, McDermott MP, Wiebe S, et al. Design considerations for a multicenter randomized controlled trial of early surgery for mesial temporal lobe epilepsy. Epilepsia. 2010;51:1978–86.

    Article  PubMed  Google Scholar 

  26. Wiebe S, Blume WT, Girvin JP, Eliasziw M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345:311–8.

    Article  PubMed  CAS  Google Scholar 

  27. Spencer D, Gwinn R, Salinsky M, O’Malley JP. Laterality and temporal distribution of seizures in patients with bitemporal independent seizures during a trial of responsive neurostimulation. Epilepsy Res. 2011;93:221–5.

    Article  PubMed  Google Scholar 

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Disclosure

Conflicts of interest: P.R. Gigante: none; R.R. Goodman: serves on the Scientific Advisory Board for Medtronic and is a consultant for NeuroPace.

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Authors and Affiliations

  1. Department of Neurological Surgery, Columbia University, 710 West 168th Street, New York, NY, 10032, USA

    Paul R. Gigante & Robert R. Goodman

  2. Department of Neurological Surgery, St. Luke’s-Roosevelt, 1000 Tenth Avenue, Suite 5G-80, New York, NY, 10019, USA

    Robert R. Goodman

Authors
  1. Paul R. Gigante
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  2. Robert R. Goodman
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Correspondence to Paul R. Gigante.

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Gigante, P.R., Goodman, R.R. Alternative Surgical Approaches in Epilepsy. Curr Neurol Neurosci Rep 11, 404–408 (2011). https://doi.org/10.1007/s11910-011-0209-8

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