Authors :
Presenting Author: Arthur Cukiert, MD, PhD – São Paulo Epilepsy Clinic
Cristine Cukiert, MD – Sao Paulo Epilepsy Clinic
Rafael Guimaraes, MD – Clinica Cukiert
Jose Burattini, MD – Clinica Cukiert
Julia Vieira, MD – Clinica Cukiert
Vanessa Colares, MD – Sao Paulo Epilepsy Clinic
Pamela Capitao, MD – Clinica Cukiert
Rationale:
Neuromodulation has been increasingly used to treat refractory epilepsy. Hippocampal DBS emerged as a safe and efficacious treatment modality available for treatment of patients with refractory temporal lobe epilepsy who are not candidates for resection for any reason. Published results appear to be superior to ANT-DBS or RNS in terms of responders and seizure free patients. Early in our series, we used OCD DBS electrodes. More recently, we changed the surgical technique to better cover the hippocampal formation, using two in-tandem electrodes.
Methods:
Six adult patients with refractory temporal lobe epilepsy were submitted to Hip-DBS using in-tandem electrodes. Three patients had normal MRI and 3 patients had bilateral periventricular heterotopia. Five patients were implanted bilaterally and one unilaterally. A stereotactic intraoperative CT was fused to preoperative MRI data for direct targeting using a sigle posterior occipital burr hole approach, under general anesthesia. The more anterior electrode was aimed at the anterior portion of the hippocampal head and the posterior one was aimed 2 mm behind the expected end of the anterior electrode. In patients with bilateral implants, a quadripolar IPG was used.
Results:
Electrodes were well aligned with the hippocampal axis and there was no direct conflict within the cables. There was no morbidity or mortality. Impedance ranged from 900 to 1900 Ω.
Conclusions:
The technique offers better coverage of the hippocampus than the previous one, allowing for the inclusion of a larger number of contacts and directionality as well. This allows more flexibility during programming and helps to avoid side effects such as peduncle recruitment during high intensity DBS.
Funding: none