Abstract
Objective: We investigate the clinical outcome from stimulation of the mamillothalamic tract in three patients with intractable epilepsy secondary to varying aetiologies. The first two had hypothalamic hamartomas and the third patient’s epilepsy presented on a background of mesial temporal sclerosis. It has been demonstrated from animal data in the pentylenetetrazol seizure model that the mamillothalamic tract (MMT) can be involved in transmitting subcortical ictal activity, via the anterior nucleus of the thalamus to the frontal cortex. Further, human data recording from the MMT and mammillary body have demonstrated that seizure activity of temporal lobe origin is also transmitted via the ipsilateral MMT.
Methods: All patients underwent a single deep brain stimulating electrode lying adjacent to the MMT and were assessed with pre and post operative QOL and neuropsychological assessments.
Results: One patient remains seizure free and the other two had a 50−70% reduction in both their seizure activity and severity. One of the patients has had significant continued development in her intellectual functioning leading her to return to school after a period of 2 years.
Conclusions: DBS for epilepsy is currently an experimental procedure and is used mainly to tackle refractory epilepsy not amenable to traditional epilepsy surgery. By targeting the MMT, we have demonstrated for the first time, control of seizure activity associated with hypothalamic hamartomas and mesial temporal sclerosis. In the search for suitable targets to treat this common and disabling condition, the MMT provides a potential solution that warrants further clinical trials.
Methods: All patients underwent a single deep brain stimulating electrode lying adjacent to the MMT and were assessed with pre and post operative QOL and neuropsychological assessments.
Results: One patient remains seizure free and the other two had a 50−70% reduction in both their seizure activity and severity. One of the patients has had significant continued development in her intellectual functioning leading her to return to school after a period of 2 years.
Conclusions: DBS for epilepsy is currently an experimental procedure and is used mainly to tackle refractory epilepsy not amenable to traditional epilepsy surgery. By targeting the MMT, we have demonstrated for the first time, control of seizure activity associated with hypothalamic hamartomas and mesial temporal sclerosis. In the search for suitable targets to treat this common and disabling condition, the MMT provides a potential solution that warrants further clinical trials.
| Original language | English |
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| Pages | 82 |
| Number of pages | 1 |
| DOIs | |
| Publication status | Published - Sept 2009 |