Neuromodulation of Bilateral Hippocampal Foci, an Alternative for Mesial Temporal Lobe Seizures in Patients with Non-Lesional MRI: Long-Term Follow-upVelasco F1, Vázquez-Barrón D2, Pérez-Pérez D3, Cuéllar-Herrera M1, Trejo D1, Montes de Oca M2 and Velasco AL4*
- *Corresponding Author:
- Dr. Ana Luisa Velasco
Head of the Epilepsy Clinic, Stereotactical and Functional Neurosurgery Unit
Eduardo Liceaga General Hospital of Mexico, Mexico
E-mail: [email protected]
Received date: September 23, 2016; Accepted date: October 12, 2016; Published date: October 16, 2016
Citation: Velasco F, Vázquez-Barrón D, Pérez-Pérez D, Cuéllar-Herrera M, Trejo D, Montes de Oca M, Velasco AL (2016) Neuromodulation of Bilateral Hippocampal Foci, an Alternative for Mesial Temporal Lobe Seizures in Patients with Non-Lesional MRI: Long-Term Follow-up. Epilepsy J 2:116. doi:10.4172/2472-0895.1000116
Copyright: © 2016 Velasco F, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Patients with bilateral independent hippocampal refractory seizures, who show no evidence of lesion in the MRI, constitute a challenge for their treatment. The risk of severe retrograde amnesia and/or residual seizures is high when bilateral temporal lobectomy is performed. Several groups have reported electrical neuromodulation of the hippocampus as a reversible surgical alternative for mesial temporal lobe epilepsy seizures that are refractory to medical treatment.
Methods: In the Epilepsy Clinic of the General Hospital we have had three patients with bilateral independent foci and non-lesional MRI. The present publication shows their long-term seizure status and their neuropsychological outcome. Stimulation parameters were 3.0 V amplitude, high frequency (130 Hz), 450 μs pulse width, one minute ON and 4 min OFF cyclic stimulation. Follow-up extended over 9 years.
Results: Patients showed dramatic seizure reduction. In two patients in whom stimulation was stopped (due to battery depletion or skin erosion), seizure reduction persisted for months after stimulation stopped, but eventually seizures reappeared slowly. One patient has had uninterrupted stimulation and has been seizure free for nine years. The neuropsychological tests showed no functional decrease at the selected modulation parameters.
Conclusion: Bilateral hippocampal stimulation is effective in seizure control in patients in whom ablative surgery is not recommended.