A multicenter, prospective pilot study of gamma knife radiosurgery for mesial temporal lobe epilepsy: Seizure response, adverse events, and verbal memory†
Corresponding Author
Nicholas M. Barbaro MD
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA
Department of Neurology, University of California at San Francisco, San Francisco, CA
Box 0112 UCSF Neurosurgery, 505 Parnassus Avenue, San Francisco, CA 94143Search for more papers by this authorMark Quigg MD, MSc
Department of Neurology, University of Virginia, Charlottesville, VA
Search for more papers by this authorDonna K. Broshek PhD
Department of Behavioral Medicine, University of Virginia, Charlottesville, VA
Search for more papers by this authorMariann M. Ward RN, NP
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorKathleen R. Lamborn PhD
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorKenneth D. Laxer MD
Pacific Epilepsy Program, California Pacific Medical Center
Search for more papers by this authorDavid A. Larson PhD, MD
Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorWilliam Dillon MD
Department of Radiology, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorLynn Verhey PhD
Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorPaul Garcia MD
Department of Neurology, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorLadislau Steiner MD, PhD
Department of Neurological Surgery, University of Virginia, Charlottesville, VA
Search for more papers by this authorChristine Heck MD
Department of Neurology, University of Southern California, Los Angeles, CA
Search for more papers by this authorDouglas Kondziolka MD, MSc
University of Pittsburgh, Pittsburgh, PA
Search for more papers by this authorRobert Beach MD
State University of New York, Upstate Medical Center, Syracuse, NY
Search for more papers by this authorThomas C. Witt MD
Department of Neurological Surgery, Indiana University, Indianapolis, IN
Search for more papers by this authorVicenta Salanova MD
Department of Neurology, Indiana University, Indianapolis, IN
Search for more papers by this authorCorresponding Author
Nicholas M. Barbaro MD
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA
Department of Neurology, University of California at San Francisco, San Francisco, CA
Box 0112 UCSF Neurosurgery, 505 Parnassus Avenue, San Francisco, CA 94143Search for more papers by this authorMark Quigg MD, MSc
Department of Neurology, University of Virginia, Charlottesville, VA
Search for more papers by this authorDonna K. Broshek PhD
Department of Behavioral Medicine, University of Virginia, Charlottesville, VA
Search for more papers by this authorMariann M. Ward RN, NP
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorKathleen R. Lamborn PhD
Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorKenneth D. Laxer MD
Pacific Epilepsy Program, California Pacific Medical Center
Search for more papers by this authorDavid A. Larson PhD, MD
Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorWilliam Dillon MD
Department of Radiology, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorLynn Verhey PhD
Department of Radiation Oncology, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorPaul Garcia MD
Department of Neurology, University of California at San Francisco, San Francisco, CA
Search for more papers by this authorLadislau Steiner MD, PhD
Department of Neurological Surgery, University of Virginia, Charlottesville, VA
Search for more papers by this authorChristine Heck MD
Department of Neurology, University of Southern California, Los Angeles, CA
Search for more papers by this authorDouglas Kondziolka MD, MSc
University of Pittsburgh, Pittsburgh, PA
Search for more papers by this authorRobert Beach MD
State University of New York, Upstate Medical Center, Syracuse, NY
Search for more papers by this authorThomas C. Witt MD
Department of Neurological Surgery, Indiana University, Indianapolis, IN
Search for more papers by this authorVicenta Salanova MD
Department of Neurology, Indiana University, Indianapolis, IN
Search for more papers by this authorPotential conflict of interest: D. Kondziolka is a paid consultant for Elekta, AB.
Abstract
Objective
The safety, efficacy, and morbidity of radiosurgery (RS) must be established before it can be offered as an alternative to open surgery for unilateral mesial temporal lobe epilepsy. We report the 3-year outcomes of a multicenter, prospective pilot study of RS.
Methods
RS was randomized to 20 or 24Gy targeting the amygdala, hippocampus, and parahippocampal gyrus. Seizure diaries evaluated the final seizure remission between months 24 and 36. Verbal memory was evaluated at baseline and 24m with the Wechsler Memory Scale–Revised (WMS-R) and California Verbal Learning Test (CVLT). Patients were classified as having “significant improvement,” “no change,” and “significant impairment” based on relative change indices.
Results
Thirteen high-dose and 17 low-dose patients were treated. Both groups showed significant reductions in seizures by 1 year after treatment. At the 36-month follow-up evaluation, 67% of patients were free of seizures for the prior 12 months (high dose: 10/13, 76.9%; low dose: 10/17, 58.8%). Use of steroids, headaches, and visual field defects did not differ by dose or seizure remission. The prevalence of verbal memory impairment was 15% (4/26 patients); none declined on more than one measure. The prevalence of significant verbal memory improvements was 12% (3/26).
Interpretation
RS for unilateral mesial temporal lobe epilepsy offers seizure remission rates comparable with those reported previously for open surgery. There were no major safety concerns with high-dose RS compared with low-dose RS. Additional research is required to determine whether RS may be a treatment option for some patients with mesial temporal lobe epilepsy. Ann Neurol 2009
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