Long⁃term efficacy of amygdala⁃hippocampus deep brain stimulation in the treatment of refractory medial temporal lobe epilepsy and its impact on cognitive function

Abstract

Objective To investigate the long‐term efficacy of amygdala‐hippocampus deep brain stimulation (AH ‐ DBS) in treating refractory medial temporal lobe epilepsy (mTLE) and its impact on cognitive function. Methods Seven patients with refractory mTLE who were treated at The First Medical Center of Chinese PLA General Hospital from January 2014 to December 2018 were enrolled in this study. All 7 patients underwent AH ‐DBS. Seizure types, seizure frequency, and antiepileptic seizure medicine (ASM) usage were compared before and after surgery. Cognitive function was assessed using Wechsler Adult Intelligence Scale ‐ Revised (WAIS ‐ R). Post ‐ operative stimulation parameters and surgery ‐ related complications were recorded. Results Of the 7 patients, 4 patients received bilateral AH‐DBS, 2 patients received left AH ‐ DBS, and one patient received left AH ‐ DBS combined with right anterior temporal lobectomy. There were 6 patients underwent the occipital approach, and one patient underwent the frontal approach. Only one patient experienced poor healing of the scalp incision, which healed after local skin grafting. The mean follow‐up period was (73.00 ± 8.98) months. During the follow‐up period, there were reductions in complex partial seizure (CPS) frequency [1.00 (0.00, 31.00) times per month vs. 2.00 (1.50, 60.00) times per month; Z = ‐ 2.207, P = 0.027], secondary generalized tonic ‐ clonic seizure (SGTCS) frequency [0.00 (0.00, 1.00) times per month vs. 2.00 (1.00, 3.00) times per month; Z = ‐ 2.428, P = 0.015], and the total seizure frequency [1.00 (0.50, 31.00) times per month vs. 5.00 (2.50, 64.00) times per month; Z = ‐ 2.366, P = 0.018]. However, there were no significant differences in the number of ASM types [1.00 (1.00, 2.00) types vs. 1.00 (1.00, 3.00) types; Z = ‐ 1.633, P = 0.102] or WAIS‐R [(85.50 ± 7.09) scores vs. (89.00 ± 9.47) scores; t = ‐ 1.761, P = 0.078] before and after surgery. Conclusions As a novel anti ‐ epileptic treatment method, AH‐DBS can reduce the frequency of refractory mTLE without serious adverse events and has no significant impact on cognitive function.

DOI: 10.3969/j.issn.1672⁃6731.2024.07.007