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Neurology. 2008 May 6;70(19):1658-63. doi: 10.1212/01.wnl.0000294326.05118.d8. Epub 2008 Apr 9.

Long-term efficacy of gamma knife radiosurgery in mesial temporal lobe epilepsy.

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  • 1Département de Neurophysiologie Clinique, Assistance Publique-Hôpitaux de Marseille, Hôpital Timone, Marseille, France. fbartolo@medecine.univ-mrs.fr

Abstract

BACKGROUND:

Gamma knife (GK) radiosurgery has been proposed as an alternative to classic microsurgery in mesial temporal lobe epilepsy (MTLE). Short-term follow-up studies have reported encouraging results, but long-term efficacy is not known.

OBJECTIVE:

To report the efficacy and tolerance of GK radiosurgery in MTLE after a follow-up > 5 years.

METHODS:

Patients with a follow-up > 5 years presenting with MTLE and treated with a marginal dose of 24 Gy were included in the study.

RESULTS:

Fifteen patients were included. Eight were treated on the left side, and 7 were treated on the right. The mean follow-up was 8 years (range 6-10 years). At the last follow-up, 9 of 16 patients (60%) were considered seizure free (Engel Class I) (4/16 in Class IA, 5/16 in Class IB). Seizure cessation occurred with a mean delay of 12 months (+/- 3) after GK radiosurgery, often preceded by a period of increasing aura or seizure occurrence (6/15 patients). The mean delay of appearance of the first neuroradiologic changes was 12 months (+/- 4). Nine patients (60%) experienced mild headache and were placed on corticosteroid treatment for a short period. All patients who were initially seizure free experienced a relapse of isolated aura (10/15, 66%) or complex partial seizures (10/15, 66%) during antiepileptic drug tapering. Restoration of treatment resulted in good control of seizures.

CONCLUSION:

Gamma knife radiosurgery is an effective and safe treatment for mesial temporal lobe epilepsy. Results are maintained over time with no additional side effects. Long-term results compare well with those of conventional surgery.

Comment in

PMID:
18401026
[PubMed - indexed for MEDLINE]
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