Gamma knife radiosurgery for refractory medial temporal lobe epilepsy

Epilepsy

GKNS has been introduced as an alternative to microsurgery for the treatment of certain types of focal epilepsy. It was first noted that epilepsy associated with AVMs often improved before the obliteration of the vascular lesion. It was subsequently shown that the treatment could be effective in mesial temporal lobe epilepsy (MTLE) producing remission in around 60% of patients, provided the treatment was carried out as originally designed. GKNS has also been useful in the treatment of gelastic epilepsy associated with hypothalamic hamartomas.

Management of epilepsy in drug-resistant patients

Epilepsy affects > 2 million people in the United States, making it one of the most common neurobiological conditions. Typically, epilepsy is treated with one of several available antiepileptic drugs and patients are able to experience freedom from seizures with minimal side effects. However, there are some patients who do not respond to treatment and require the use of multiple drug combinations or surgical intervention. Although there are few studies supporting its use, multi-drug regimens have been known to be helpful for patients, although clinicians should monitor patients for adverse side effects. Vagus nerve stimulation is the only US Food and Drug Administration-approved surgical neurostimulation therapy for epilepsy, and patients' conditions often progress for many years before epilepsy surgery options are considered. Lastly, due to the chronic nature of epilepsy, clinicians should be aware of the presence of comorbid psychiatric conditions as well. This supplement is Part One in the "Case in Point: Evidence-Based Insights for Epilepsy Management" series. In this Expert Review Supplement, Andrew J. Cole, MD, FRCPC, outlines a case of a patient with drug resistant epilepsy, and Brien J. Smith, MD, outlines the best practices for the case patient including discussion on defining drug resistance in patients as well as the benefits and risks of available and emerging drug and surgical treatments.