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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 66, Number 10, May 23, 2006 All Versions of this Article: 01.wnl.0000209300.49308.8fv1 66/10/1490    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tellez-Zenteno, J. F. Articles by Wiebe, S. Search for Related Content PubMed PubMed Citation Articles by Tellez-Zenteno, J. F. Articles by Wiebe, S.

Hippocampal electrical stimulation in mesial temporal lobe epilepsy

From the Department of Clinical Neurological Sciences, University of Western Ontario, and London Health Sciences Centre, London, Ontario, Canada.

Address correspondence and reprint requests to Dr. Samuel Wiebe, Foothills Medical Centre, 1403–29 Street NW, Calgary, Alberta, Canada, T2N 2T9; e-mail: swiebe{at}ucalgary.ca

Background: Adjustable, reversible therapies are needed for patients with pharmacoresistant epilepsy. Electrical stimulation of the hippocampus has been proposed as a possible treatment for mesial temporal lobe epilepsy (MTLE).

Methods: Four patients with refractory MTLE whose risk to memory contraindicated temporal lobe resection underwent implantation of a chronic stimulating depth electrode along the axis of the left hippocampus. The authors used continuous, subthreshold electrical stimulation (90 µsec, 190 Hz) and a double blind, multiple cross-over, randomized controlled design, consisting of three treatment pairs, each containing two 1-month treatment periods. During each treatment pair the stimulator was randomly turned ON 1 month and OFF 1 month. Outcomes were assessed at monthly intervals in a double blind manner, using standardized instruments and accounting for a washout period. The authors compared outcomes between ON, OFF, and baseline periods.

Results: Hippocampal stimulation produced a median reduction in seizures of 15%. All but one patient’s seizures improved; however, the results did not reach significance. Effects seemed to carry over into the OFF period, and an implantation effect cannot be ruled out. The authors found no significant differences in other outcomes. There were no adverse effects. One patient has been treated for 4 years and continues to experience substantial long-term seizure improvement.

Conclusion: The authors demonstrate important beneficial trends, some long-term benefits, and absence of adverse effects of hippocampal electrical stimulation in mesial temporal lobe epilepsy. However, the effect sizes observed were smaller than those reported in non-randomized, unblinded studies.

Editorial, see page 1468

See also page 1571

This article was previously published in electronic format as an Expedited E-Pub on March 22, 2006, at www.neurology.org.

Disclosure: The authors report no conflicts of interest.

Received August 11, 2005. Accepted in final form January 23, 2006.

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				R. P. Lesser and W. H. Theodore If not pharmacology, maybe physics Neurology, May 23, 2006; 66(10): 1468 - 1469. [Full Text] [PDF]