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

From Département de Neurophysiologie Clinique (F.B., M.R., P.C.), Département de Neurochirurgie Fonctionnelle et Stéréotaxique (M.H., M.T., J.R.), Assistance Publique–Hôpitaux de Marseille, Hôpital Timone, Marseille, France; Faculté de Médecine (F.B., M.R., P.C., J.R.), Aix Marseille Université, Marseille, France; Inserm (F.B., P.C., J.R.), U 751, Marseille, France; and Service de Neurologie fonctionnelle (C.F.), Hôpital Neurologique, Lyon, France.

Address correspondence and reprint requests to Dr. Fabrice Bartolomei, Service de Neurophysiologie Clinique, CHU Timone-264 Rue st Pierre, 13005-Marseille, France fbartolo{at}medecine.univ-mrs.fr

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.

Abbreviations: AED = antiepileptic drug; ATL = anterior temporal lobectomy; FS = febrile seizures; GK = gamma knife; MR = magnetic resonance; MTLE = mesial temporal lobe epilepsy; MTLE-HS = mesial temporal lobe epilepsy associated with hippocampal sclerosis; NA = not available; NI = not improved; SF = seizure free; SGTCS = preoperative secondary generalized tonic–clonic seizures; SUDEP = sudden unexpected death in epilepsy; WMS = Wechsler Memory Scale; Ve = verbal category; Vi = visual category.

Editorial, page 1654

e-Pub ahead of print on April 9, 2008, at www.neurology.org.

Disclosure: The authors report no disclosures.

Received March 13, 2007. Accepted in final form August 21, 2007.

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