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Resection After Responsive Neurostimulation for Bilateral Mesial Temporal Epilepsy: Why Continuing Neurostimulation
Lia de Leon Ernst1, Ahmed M Raslan2, Christopher Zimmerman1
1Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA; and.
Summary
Responsive neurostimulation (RNS) may need to continue after epilepsy surgery for bilateral mesial temporal lobe epilepsy (MTLE). Increased stimulation may be key for seizure freedom in these refractory cases.
Area of Science:
- Neurology
- Neurosurgery
- Epilepsy Research
Background:
- Refractory bilateral mesial temporal lobe epilepsy (MTLE) presents treatment challenges.
- Responsive neurostimulation (RNS) is an option for select patients.
- The role of continued RNS after unilateral resection is not well-defined.
Purpose of the Study:
- To evaluate the utility of continued RNS therapy after unilateral temporal lobe resection in patients with bilateral MTLE.
- To establish guiding principles for neurostimulation management post-resection.
Main Methods:
- Retrospective chart review of patients with bilateral MTLE treated with RNS.
- Analysis of outcomes following selective mesial temporal lobe resection and continued RNS.
Main Results:
- Four out of five patients achieved immediate seizure freedom post-resection.
- One patient required increased RNS stimulation to achieve seizure freedom after initial partial response.
- Continued RNS with ipsilateral monitoring and contralateral stimulation was effective; stimulation interruption led to seizure relapse in two patients.
Conclusions:
- Unilateral seizure remission in RNS-treated bilateral MTLE may be stimulation-dependent.
- Continuing RNS therapy after unilateral resection is recommended.
- The number of daily stimulations may influence seizure remission thresholds.
