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Long-term efficacy and cognitive effects of bilateral hippocampal deep brain stimulation in patients with drug-resistant temporal lobe epilepsy

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Abstract

Purpose

Temporal lobe epilepsy patients treated with hippocampal deep brain stimulation (Hip-DBS) have rarely been reported before. Preoperative and postoperative cognitive function is seldom analyzed.

Methods

Seven patients with drug-resistant temporal lobe epilepsy were included in this study. Bilateral Hip-DBS was performed in these patients. The stimulator was activated 1 month after the implantation. Then, the patients returned for further adjustments 4 months after the surgery and reprogramming every year. The seizure frequency, Wechsler Adult Intelligence Scale-IV, and Wechsler memory scale-IV were assessed blindly as the outcomes at each follow-up.

Results

After a mean 48-month follow-up, the mean seizure frequency significantly decreased (p = 0.011, paired t test; decrease of 78.1%). One patient (14.3%) was seizure-free by the last follow-up; six of seven (85.7%) patients had reductions in seizure frequency of at least 50%; one patient (14.3%) who did not comply with the antiepileptic drug instructions had a less than 50% reduction in seizure frequency. In addition, there were no significant decreases in intelligence or verbal and visual memory from baseline to the last follow-up (p = 0.736, paired t test; p = 0.380, paired t test, respectively).

Conclusion

Hip-DBS could provide acceptable long-term efficacy and safety. For patients with drug-resistant temporal lobe epilepsy who are not suitable for resective surgery, Hip-DBS could become a potential therapeutic option.

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Abbreviations

AED:

Antiepileptic drug

DBS:

Deep brain stimulation

ANT-DBS:

Anterior nucleus thalamus deep brain stimulation

Hip-DBS:

Hippocampal deep brain stimulation

SPS:

Simple partial seizures

CPS:

Complex partial seizures

GTCS:

Generalized tonic-clonic seizures

WAIS-IV:

Wechsler Adult Intelligence Scale-IV

WMS-IV:

Wechsler Memory Scale-IV

FSIQ:

Full-Scale Intelligence Quotient

FSMQ:

Full-Scale Memory Quotient

AMI:

Auditory Memory Index

VMI:

Visual Memory Index

MTS:

Mesial temporal sclerosis

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Authors and Affiliations

  1. Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China

    Shu Wang, Meng Zhao, Chunsheng Zhang, Jian Zhou, Xiongfei Wang, Kaiqiang Ma, Guoming Luan & Yuguang Guan

  2. Department of Neurology, SanBo Brain Hospital, Capital Medical University, Beijing, 100093, China

    Tianfu Li & Mengyang Wang

  3. Beijing Key Laboratory of Epilepsy, Beijing, 100093, China

    Tianfu Li, Guoming Luan & Yuguang Guan

  4. Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, 100093, China

    Tianfu Li, Guoming Luan & Yuguang Guan

Authors
  1. Shu Wang
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Contributions

Shu Wang: Finish the manuscript, data analysis.

Meng Zhao: Revision, data collation.

Tianfu Li: Select patients, assessment of the scale.

Chunsheng Zhang: Follow-up, data collation.

Jian Zhou: Revision, data collation.

Mengyang Wang: Select patients, assessment of the scale.

Xiongfei Wang: Revision, data collation.

Kaiqiang Ma: Follow-up, data collation.

Guoming Luan: Team leader, Revision, select patients.

Yuguang Guan: Team leader, Revision, select patients.

Corresponding author

Correspondence to Yuguang Guan.

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Conflict of interest

The authors declare that they have no conflict of interest.

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None.

Research ethics

The local ethics committee approved this study. Written informed consent was provided by the patients or their guardians. All patients agreed to the procedure and to the use of their anonymized data for research purposes. This study was conducted following the 1964 Helsinki Declaration and its later amendments.

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Wang, S., Zhao, M., Li, T. et al. Long-term efficacy and cognitive effects of bilateral hippocampal deep brain stimulation in patients with drug-resistant temporal lobe epilepsy. Neurol Sci 42, 225–233 (2021). https://doi.org/10.1007/s10072-020-04554-8

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