Deep brain stimulation of the subiculum in the treatment for refractory temporal lobe epilepsy due to unilateral mesial temporal lobe sclerosis
•Hippocampal sclerosis is the most common cause of temporal lobe epilepsy.•Hippocampal sclerosis typically involves the hippocampus proper and dentate gyrus while sparing the subiculum.•Deep brain stimulation of the subiculum may be a treatment option for severe hippocampal sclerosis.•The subiculum...
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| Published in: | Epilepsy & behavior reports Vol. 27; p. 100677 |
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| Abstract | •Hippocampal sclerosis is the most common cause of temporal lobe epilepsy.•Hippocampal sclerosis typically involves the hippocampus proper and dentate gyrus while sparing the subiculum.•Deep brain stimulation of the subiculum may be a treatment option for severe hippocampal sclerosis.•The subiculum may be a target for treating drug-resistant epilepsy.•Subicular stimulation reduced seizures by 67 % in our patient over 20 months.
Temporal lobe epilepsy (TLE) is the most common form of drug-resistant epilepsy. The main pathological changes primarily involve hippocampal sclerosis (HS). Early resective surgery of the sclerotic hippocampus is typically associated with favorable clinical outcomes. However, not all patients are suitable candidates for resective surgery of mesial temporal lobe structures. Therefore, alternative treatment modalities should be considered. We present the case of a 50-year-old right-handed woman with left HS who underwent unilateral subiculum stimulation for drug-resistant epilepsy (DRE). Since the age of 10, the patient had been experiencing focal to bilateral tonic-clonic seizures (FBTCS). Despite multiple antiseizure medications, she experienced 12 to 17 FBTCS per month in the last two years. Due to concerns about potential memory decline and personal preferences, she refused resective surgery. As an alternative, the patient underwent left unilateral subiculum stimulation. The stimulation resulted in a nearly 67 % reduction in seizure frequency at the last follow-up (20 months after surgery). This case highlights that drug-resistant epilepsy may be effectively treated with subicular stimulation in patients with HS. |
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| AbstractList | •Hippocampal sclerosis is the most common cause of temporal lobe epilepsy.•Hippocampal sclerosis typically involves the hippocampus proper and dentate gyrus while sparing the subiculum.•Deep brain stimulation of the subiculum may be a treatment option for severe hippocampal sclerosis.•The subiculum may be a target for treating drug-resistant epilepsy.•Subicular stimulation reduced seizures by 67 % in our patient over 20 months.
Temporal lobe epilepsy (TLE) is the most common form of drug-resistant epilepsy. The main pathological changes primarily involve hippocampal sclerosis (HS). Early resective surgery of the sclerotic hippocampus is typically associated with favorable clinical outcomes. However, not all patients are suitable candidates for resective surgery of mesial temporal lobe structures. Therefore, alternative treatment modalities should be considered. We present the case of a 50-year-old right-handed woman with left HS who underwent unilateral subiculum stimulation for drug-resistant epilepsy (DRE). Since the age of 10, the patient had been experiencing focal to bilateral tonic-clonic seizures (FBTCS). Despite multiple antiseizure medications, she experienced 12 to 17 FBTCS per month in the last two years. Due to concerns about potential memory decline and personal preferences, she refused resective surgery. As an alternative, the patient underwent left unilateral subiculum stimulation. The stimulation resulted in a nearly 67 % reduction in seizure frequency at the last follow-up (20 months after surgery). This case highlights that drug-resistant epilepsy may be effectively treated with subicular stimulation in patients with HS. Temporal lobe epilepsy (TLE) is the most common form of drug-resistant epilepsy. The main pathological changes primarily involve hippocampal sclerosis (HS). Early resective surgery of the sclerotic hippocampus is typically associated with favorable clinical outcomes. However, not all patients are suitable candidates for resective surgery of mesial temporal lobe structures. Therefore, alternative treatment modalities should be considered. We present the case of a 50-year-old right-handed woman with left HS who underwent unilateral subiculum stimulation for drug-resistant epilepsy (DRE). Since the age of 10, the patient had been experiencing focal to bilateral tonic-clonic seizures (FBTCS). Despite multiple antiseizure medications, she experienced 12 to 17 FBTCS per month in the last two years. Due to concerns about potential memory decline and personal preferences, she refused resective surgery. As an alternative, the patient underwent left unilateral subiculum stimulation. The stimulation resulted in a nearly 67 % reduction in seizure frequency at the last follow-up (20 months after surgery). This case highlights that drug-resistant epilepsy may be effectively treated with subicular stimulation in patients with HS. Temporal lobe epilepsy (TLE) is the most common form of drug-resistant epilepsy. The main pathological changes primarily involve hippocampal sclerosis (HS). Early resective surgery of the sclerotic hippocampus is typically associated with favorable clinical outcomes. However, not all patients are suitable candidates for resective surgery of mesial temporal lobe structures. Therefore, alternative treatment modalities should be considered. We present the case of a 50-year-old right-handed woman with left HS who underwent unilateral subiculum stimulation for drug-resistant epilepsy (DRE). Since the age of 10, the patient had been experiencing focal to bilateral tonic-clonic seizures (FBTCS). Despite multiple antiseizure medications, she experienced 12 to 17 FBTCS per month in the last two years. Due to concerns about potential memory decline and personal preferences, she refused resective surgery. As an alternative, the patient underwent left unilateral subiculum stimulation. The stimulation resulted in a nearly 67 % reduction in seizure frequency at the last follow-up (20 months after surgery). This case highlights that drug-resistant epilepsy may be effectively treated with subicular stimulation in patients with HS.Temporal lobe epilepsy (TLE) is the most common form of drug-resistant epilepsy. The main pathological changes primarily involve hippocampal sclerosis (HS). Early resective surgery of the sclerotic hippocampus is typically associated with favorable clinical outcomes. However, not all patients are suitable candidates for resective surgery of mesial temporal lobe structures. Therefore, alternative treatment modalities should be considered. We present the case of a 50-year-old right-handed woman with left HS who underwent unilateral subiculum stimulation for drug-resistant epilepsy (DRE). Since the age of 10, the patient had been experiencing focal to bilateral tonic-clonic seizures (FBTCS). Despite multiple antiseizure medications, she experienced 12 to 17 FBTCS per month in the last two years. Due to concerns about potential memory decline and personal preferences, she refused resective surgery. As an alternative, the patient underwent left unilateral subiculum stimulation. The stimulation resulted in a nearly 67 % reduction in seizure frequency at the last follow-up (20 months after surgery). This case highlights that drug-resistant epilepsy may be effectively treated with subicular stimulation in patients with HS. •Hippocampal sclerosis is the most common cause of temporal lobe epilepsy.•Hippocampal sclerosis typically involves the hippocampus proper and dentate gyrus while sparing the subiculum.•Deep brain stimulation of the subiculum may be a treatment option for severe hippocampal sclerosis.•The subiculum may be a target for treating drug-resistant epilepsy.•Subicular stimulation reduced seizures by 67 % in our patient over 20 months. Temporal lobe epilepsy (TLE) is the most common form of drug-resistant epilepsy. The main pathological changes primarily involve hippocampal sclerosis (HS). Early resective surgery of the sclerotic hippocampus is typically associated with favorable clinical outcomes. However, not all patients are suitable candidates for resective surgery of mesial temporal lobe structures. Therefore, alternative treatment modalities should be considered. We present the case of a 50-year-old right-handed woman with left HS who underwent unilateral subiculum stimulation for drug-resistant epilepsy (DRE). Since the age of 10, the patient had been experiencing focal to bilateral tonic-clonic seizures (FBTCS). Despite multiple antiseizure medications, she experienced 12 to 17 FBTCS per month in the last two years. Due to concerns about potential memory decline and personal preferences, she refused resective surgery. As an alternative, the patient underwent left unilateral subiculum stimulation. The stimulation resulted in a nearly 67 % reduction in seizure frequency at the last follow-up (20 months after surgery). This case highlights that drug-resistant epilepsy may be effectively treated with subicular stimulation in patients with HS. |
| ArticleNumber | 100677 |
| Author | Sobstyl, Michał Konopko, Magdalena Nagańska, Ewa Kowalska, Magdalena Wierzbicka, Aleksandra Karamon, Karol |
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| Keywords | Hippocampal sclerosis Mesial temporal sclerosis Deep brain stimulation Mesial temporal lobe epilepsy Subiculum stimulation Drug resistant epilepsy |
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| References_xml | – volume: 14 start-page: 1 year: 2022 end-page: 8 ident: b0075 article-title: Optimizing deep brain stimulation for the treatment of drug-resistant temporal lobe epilepsy: a pilot study publication-title: J Neurosurg – volume: 342 start-page: 314 year: 2000 end-page: 319 ident: b0005 article-title: Early identification of refractory epilepsy publication-title: N Engl J Med – volume: 13 start-page: 5010 year: 2022 ident: b0055 article-title: Discrete subicular circuits control generalization of hippocampal seizures publication-title: Nat Commun – volume: 88 start-page: 388 year: 2018 Nov end-page: 395 ident: b0025 article-title: Responsive neurostimulation: candidates and considerations publication-title: Epilepsy Behav – volume: 62 start-page: 190 year: 2021 end-page: 197 ident: b0080 article-title: Long term seizure outcome during continuous bipolar hippocampal deep brain stimulation in patients with temporal lobe epilepsy with or without mesial temporal lobe sclerosis: an observational open label study publication-title: Epilepsia – volume: 48 start-page: 1895 year: 2007 Oct end-page: 1903 ident: b0020 article-title: Electrical stimulation of the hippocampal epileptic foci for seizure control: a double-blind, long-term follow-up study publication-title: Epilepsia – volume: 2012 year: 2012 ident: b0065 article-title: Temporal lobe epilepsy surgery failures: a review publication-title: Epilepsy Res Treat – volume: 58 start-page: 994 year: 2017 Jun end-page: 1004 ident: b0030 article-title: Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy publication-title: Epilepsia – volume: 111 start-page: 181 year: 2018 end-page: 189 ident: b0040 article-title: Robotic-guided bihippocampal and biparahippocampal depth placement for responsive neurostimulation in bitemporal lobe epilepsy publication-title: World Neurosurg – volume: 20 start-page: 485 year: 2011 Jul end-page: 490 ident: b0045 article-title: Chronic deep brain stimulation in mesial temporal lobe epilepsy publication-title: Seizure – volume: 307 start-page: 922 year: 2012 end-page: 930 ident: b0015 article-title: Early Randomized Surgical Epilepsy Trial (ERSET) Study Group. 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| Snippet | •Hippocampal sclerosis is the most common cause of temporal lobe epilepsy.•Hippocampal sclerosis typically involves the hippocampus proper and dentate gyrus... Temporal lobe epilepsy (TLE) is the most common form of drug-resistant epilepsy. The main pathological changes primarily involve hippocampal sclerosis (HS).... |
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| SubjectTerms | Deep brain stimulation Drug resistant epilepsy Hippocampal sclerosis Mesial temporal lobe epilepsy Mesial temporal sclerosis Subiculum stimulation |
| Title | Deep brain stimulation of the subiculum in the treatment for refractory temporal lobe epilepsy due to unilateral mesial temporal lobe sclerosis |
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