Bilateral radiofrequency anterior thalamotomy in intractable epilepsy patients.

BACKGROUND

Identification of the crucial role of the anterior thalamic nuclei (ATN) in the generalization of seizures led to increased interest in surgical interventions in this particular area in intractable epilepsy patients. Simulation of ATN destruction in animals demonstrated its high efficacy for both preventing the seizure development and reducing the seizure rate. However, bilateral radiofrequency destruction of the anterior thalamic nuclei in humans has not yet bee described.

AIM

The study objective was to perform bilateral radiofrequency anterior thalamotomy in intractable epilepsy patients and to evaluate its

MATERIAL AND METHODS

We performed for the first time bilateral stereotactic radiofrequency thermocoagulation of ATN in 13 patients with long-term intractable epilepsy. Before surgery, we assessed the disease duration, age of seizure onset, localization of pathological activity sources, and types of seizures, morphological damages, and ongoing pharmacotherapy. All interventions were performed under local anesthesia and were accompanied by intraoperative microelectrode monitoring of the neuronal activity and by EEG.

RESULTS

Seven males and 6 females, aged 22 to 48 years, were operated on. All patients had epileptogenic foci in the frontal and/or temporal lobes. MRI revealed epileptogenic structural abnormalities in 3 patients. There were no postoperative complications. According to a postoperative examination, 5 patients were seizure-free; a decrease in the seizure rate was 70% in 6 patients and 50% in 1 patient; 1 patient had no response to the surgery. The resulting effect was manifested not only in a reduction in the frequency and severity of seizures but also in a decrease in the dose of administered anticonvulsants. EEG also showed a significant improvement in the majority of patients.

CONCLUSION

Our experience demonstrates that bilateral radiofrequency anterior thalamotomy is a safe and effective technique to control seizures in humans. Further research will clarify, based on the clinical and EEG data, the patient selection criteria for surgical treatment.