Sobstyl Michał, Kowalska Magdalena, Konopko Magdalena, Wierzbicka Aleksandra, Karamon Karol, Nagańska Ewa
Department of Neurosurgery, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw, Poland.
Department of Neurology and Epileptology, Independent Public Clinical Hospital, Medical Center for Postgraduate Education, Czerniakowska 231 Street, 00-416 Warsaw, Poland.
Epilepsy Behav Rep. 2024 May 24;27:100677. doi: 10.1016/j.ebr.2024.100677. eCollection 2024.
Temporal lobe epilepsy (TLE) is the most common form of drug-resistant epilepsy. The main pathological changes primarily involve hippocampal sclerosis (HS). Early resective surgery of the sclerotic hippocampus is typically associated with favorable clinical outcomes. However, not all patients are suitable candidates for resective surgery of mesial temporal lobe structures. Therefore, alternative treatment modalities should be considered. We present the case of a 50-year-old right-handed woman with left HS who underwent unilateral subiculum stimulation for drug-resistant epilepsy (DRE). Since the age of 10, the patient had been experiencing focal to bilateral tonic-clonic seizures (FBTCS). Despite multiple antiseizure medications, she experienced 12 to 17 FBTCS per month in the last two years. Due to concerns about potential memory decline and personal preferences, she refused resective surgery. As an alternative, the patient underwent left unilateral subiculum stimulation. The stimulation resulted in a nearly 67 % reduction in seizure frequency at the last follow-up (20 months after surgery). This case highlights that drug-resistant epilepsy may be effectively treated with subicular stimulation in patients with HS.
颞叶癫痫（TLE）是最常见的耐药性癫痫形式。主要病理变化主要涉及海马硬化（HS）。早期切除硬化的海马通常与良好的临床结果相关。然而，并非所有患者都适合进行内侧颞叶结构的切除手术。因此，应考虑其他治疗方式。我们报告了一例50岁右利手女性，患有左侧HS，因耐药性癫痫（DRE）接受了单侧下托刺激治疗。自10岁起，该患者就一直经历局灶性继发双侧强直阵挛发作（FBTCS）。尽管使用了多种抗癫痫药物，但在过去两年中，她每月仍经历12至17次FBTCS。由于担心潜在的记忆力下降和个人偏好，她拒绝了切除手术。作为替代方案，该患者接受了左侧单侧下托刺激。在最后一次随访（手术后20个月）时，刺激使癫痫发作频率降低了近67%。该病例表明，对于患有HS的患者，下托刺激可能有效治疗耐药性癫痫。
