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Low-frequency stimulation of a fiber tract in bilateral temporal lobe epilepsy.
Koubeissi, Mohamad Z; Joshi, Sweta; Eid, Alexandra; Emami, Mehrdad; Jaafar, Nadim; Syed, Tanvir; Foreman, Perry J; Sheth, Anumeha; Amdur, Richard; Bou Nasif, Mei; Puente, Antonio N; Aly, Radwa; Chen, Hai; Becker, Andrew; Gholipour, Taha; Makke, Yamane; Elmashad, Ahmed; Gagnon, Linda; Durand, Dominique M; Gaillard, William D; Shields, Donald C.
Afiliação
  • Koubeissi MZ; Department of Neurology, The George Washington University, Washington, DC 20052, USA. Electronic address: mkoubeissi@mfa.gwu.edu.
  • Joshi S; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Eid A; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Emami M; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Jaafar N; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Syed T; SOC Telemed, Reston, VA 20190, USA.
  • Foreman PJ; Department of Neurology, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA.
  • Sheth A; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Amdur R; Department of Surgery, George Washington University School of Medicine, Washington, DC 20052, USA.
  • Bou Nasif M; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Puente AN; Department of Psychiatry, George Washington University School of Medicine, Washington, DC 20052, USA.
  • Aly R; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Chen H; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Becker A; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Gholipour T; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Makke Y; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Elmashad A; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Gagnon L; Department of Neurology, The George Washington University, Washington, DC 20052, USA.
  • Durand DM; Neural Engineering Center, Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA.
  • Gaillard WD; Center for Neuroscience and Behavioral Health, Children's National Hospital, Washington, DC 20010, USA.
  • Shields DC; Department of Neurosurgery, The George Washington University, Washington, DC 20052, USA.
Epilepsy Behav ; 130: 108667, 2022 05.
Article em En | MEDLINE | ID: mdl-35344808
ABSTRACT

OBJECTIVE:

Pharmacoresistant bilateral mesial temporal lobe epilepsy often implies poor resective surgical candidacy. Low-frequency stimulation of a fiber tract connected to bilateral hippocampi, the fornicodorsocommissural tract, has been shown to be safe and efficacious in reducing seizures in a previous short-term study. Here, we report a single-blinded, within-subject control, long-term deep-brain stimulation trial of low-frequency stimulation of the fornicodorsocommissural tract in bilateral mesial temporal lobe epilepsy. Outcomes of interest included safety with respect to verbal memory scores and reduction of seizure frequency.

METHODS:

Our enrollment goal was 16 adult subjects to be randomized to 2-Hz or 5-Hz low-frequency stimulation of the fornicodorsocommissural tract starting at 2 mA. The study design consisted of four two-month blocks of stimulation with a 50%-duty cycle, alternating with two-month blocks of no stimulation.

RESULTS:

We terminated the study after enrollment of five subjects due to slow accrual. Fornicodorsocommissural tract stimulation elicited bilateral hippocampal evoked responses in all subjects. Three subjects underwent implantation of pulse generators and long-term low-frequency stimulation with mean monthly seizures of 3.14 ±â€¯2.67 (median 3.0 [IQR 1-4.0]) during stimulation-off blocks, compared with 0.96 ±â€¯1.23 (median 1.0 [IQR 0-1.0]) during stimulation-on blocks (p = 0.0005) during the blinded phase. Generalized Estimating Equations showed that low-frequency stimulation reduced monthly seizure-frequency by 0.71 per mA (p < 0.001). Verbal memory scores were stable with no psychiatric complications or other adverse events.

SIGNIFICANCE:

The results demonstrate feasibility of stimulating both hippocampi using a single deep-brain stimulation electrode in the fornicodorsocommissural tract, efficacy of low-frequency stimulation in reducing seizures, and safety as regards verbal memory.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Estimulação Encefálica Profunda / Epilepsia do Lobo Temporal Tipo de estudo: Clinical_trials Limite: Adult / Humans Idioma: En Revista: Epilepsy Behav Assunto da revista: CIENCIAS DO COMPORTAMENTO / NEUROLOGIA Ano de publicação: 2022 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Estimulação Encefálica Profunda / Epilepsia do Lobo Temporal Tipo de estudo: Clinical_trials Limite: Adult / Humans Idioma: En Revista: Epilepsy Behav Assunto da revista: CIENCIAS DO COMPORTAMENTO / NEUROLOGIA Ano de publicação: 2022 Tipo de documento: Article