Hippocampal deep brain stimulation for drug-resistant epilepsy: Insights from bilateral temporal lobe and posterior epilepsy cases

• Published in: Seizure (London, England) England), 2025-01, Vol.124, p.57-65
• Main Authors: Choo, Seung Ho, Park, Hea Ree, Lee, Seunghoon, Lee, Jung-Il, Joo, Eun Yeon, Seo, Dae-Won, Hong, Seung Bong, Shon, Young-Min
• Format: Article
• Language: English
• Subjects: Bilateral temporal lobe epilepsy; Cognitive effects; Deep brain stimulation; Drug-resistant epilepsy; Hippocampal DBS; Posterior epilepsy
• ISSN: 1059-1311; 1532-2688; 1532-2688
• DOI: 10.1016/j.seizure.2024.11.018

•Hip-DBS reduces seizures by 77.8 % (disabling) and 47.9 % (non-disabling).•Long-term follow-up shows 86.7 % responder rate for disabling seizures.•Cognition stable post-Hip-DBS; some domains show improvement trends.•Hip-DBS shows promise for both bilateral temporal and posterior epilepsies. This study evaluates the long-term efficacy of hippocampal deep brain stimulation (Hip-DBS) in patients with drug-resistant epilepsy (DRE), specifically focusing on bilateral temporal lobe epilepsy (BTLE) and posterior epilepsy (PE). A retrospective analysis was conducted on 15 DRE patients (11 BTLE, 4 PE) who underwent bilateral Hip-DBS at Samsung Medical Center over an eight-year period. Medical records, seizure diaries, and neuropsychological assessments were reviewed. The surgical and follow-up protocols were adapted from our previous clinical research. The median seizure reduction rate was 77.8 % for disabling seizures (DS) and 47.9 % for non-disabling seizures (NDS). Subgroup analysis revealed a 77.8 % reduction in DS for BTLE patients and 68.8 % for PE patients. The overall responder rate was 86.7 % for DS and 50 % for NDS. Neuropsychological evaluations showed stable cognitive functions post-treatment, with a non-significant trend towards improvement in non-verbal and visuo-spatial cognitive domains. This study provides preliminary evidence supporting the efficacy of Hip-DBS in reducing seizure frequency in both BTLE and PE patients, with a more pronounced effect on disabling seizures. The potential cognitive preservation and possible enhancement in specific domains warrant further investigation. Despite limitations such as the retrospective design and reliance on self-reported seizure frequencies, these findings encourage further exploration of Hip-DBS as a treatment modality for DRE, particularly in cases where resective surgery is contraindicated.