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Abdulrazeq HF, Kimata AR, Shao B, Svokos K, Ayub N, Nie D, Asaad WF. Laser amygdalohippocampotomy reduces contralateral hippocampal sub-clinical activity in bitemporal epilepsy: A case illustration of responsive neurostimulator ambulatory recordings. Epilepsy Behav Rep 2023; 25:100636. [PMID: 38162813 PMCID: PMC10755529 DOI: 10.1016/j.ebr.2023.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Responsive neurostimulation (RNS) is a valuable tool in the diagnosis and treatment of medication refractory epilepsy (MRE) and provides clinicians with better insights into patients' seizure patterns. In this case illustration, we present a patient with bilateral hippocampal RNS for presumed bilateral mesial temporal lobe epilepsy. The patient subsequently underwent a right sided LITT amygdalohippocampotomy based upon chronic RNS data revealing predominance of seizures from that side. Analyzing electrocorticography (ECOG) from the RNS system, we identified the frequency of high amplitude discharges recorded from the left hippocampal lead pre- and post- right LITT amygdalohippocampotomy. A reduction in contralateral interictal epileptiform activity was observed through RNS recordings over a two-year period, suggesting the potential dependency of the contralateral activity on the primary epileptogenic zone. These findings suggest that early targeted surgical resection or laser ablation by leveraging RNS data can potentially impede the progression of dependent epileptiform activity and may aid in preserving neurocognitive networks. RNS recordings are essential in shaping further management decisions for our patient with a presumed bitemporal epilepsy.
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Affiliation(s)
- Hael F. Abdulrazeq
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Anna R. Kimata
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Neuroscience, Brown University, Providence, RI, United States
| | - Belinda Shao
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Konstantina Svokos
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Norman Prince Neurosciences Institute, Rhode Island Hospital & Hasbro Children’s Hospital, Providence, RI, United States
- Department of Neuroscience, Brown University, Providence, RI, United States
| | - Neishay Ayub
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Norman Prince Neurosciences Institute, Rhode Island Hospital & Hasbro Children’s Hospital, Providence, RI, United States
- Department of Neurology, Rhode Island Hospital, Providence, RI, United States
| | - Duyu Nie
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Norman Prince Neurosciences Institute, Rhode Island Hospital & Hasbro Children’s Hospital, Providence, RI, United States
- Department of Neurology, Rhode Island Hospital, Providence, RI, United States
| | - Wael F. Asaad
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, United States
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Norman Prince Neurosciences Institute, Rhode Island Hospital & Hasbro Children’s Hospital, Providence, RI, United States
- Department of Neuroscience, Brown University, Providence, RI, United States
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