Abstract
Abstract 1 P. Boon ( 1 Laboratory for Clinical and Experimental Neurophysiology (LCEN) and Department of Neuology, Ghent University Hospital, Belgium ) Acute deep brain stimulation (DBS) in various thalamic nuclei and medial temporal lobe structures has recently been shown to be efficacious in small pilot studies of patients with medically refractory epilepsy. Only limited data on chronic thalamic and amygdalohippocampal stimulation are available. Chronic DBS in these structures requires resolving many conceptual and technical issues. There is little evidence based information on rational targets and stimulation parameters. Currently available depth EEG recording electrodes are unsuitable for chronic use. Inversely, the use of DBS electrodes for intracranial EEG recording and localization of the ictal onset zone prior to stimulation has only been reported by a few groups. Results from feasibility and pilot studies in the most recent literature will be presented. The experience with DBS in temporal lobe epilepsy using quadripolar DBS electrodes bilaterally implanted in the amygdalohippocampal region to identify and subsequently stimulate the ictal onset zone will be described. This work has yielded a significant decrease of seizure counts and interictal EEG abnormalities during long-term follow-up. Various hypotheses on the possible mechanism(s) of action of DBS for epilepsy using EEG, cerebral blood flow and metabolic measures including results from animal experiments have recently been developed. Data from open pilot studies suggests that chronic DBS for epilepsy may be a feasible, effective and safe procedure that reduces interictal EEG abnormalities and seizures. Further trials with larger patient populations, controlled and randomised designs should be initiated.
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