A multicenter, prospective pilot study of gamma knife radiosurgery for mesial temporal lobe epilepsy: Seizure response, adverse events, and verbal memory

Nicholas Barbaro, Mark Quigg, Donna K. Broshek, Mariann M. Ward, Kathleen R. Lamborn, Kenneth D. Laxer, David A. Larson, William D. Dillon, Lynn Verhey, Paul Garcia, Ladislau Steiner, Christine Heck, Douglas Kondziolka, Robert Beach, William Olivero, Thomas C. Witt, Vicenta Salanova, Robert Goodman

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

Objective: The safety, efficacy, and morbidity of radiosurgery (RS) must be established before it can be offered as an alternative to open surgery for unilateral mesial temporal lobe epilepsy. We report the 3-year outcomes of a multicenter, prospective pilot study of RS. Methods: RS was randomized to 20 or 24Gy targeting the amygdala, hippocampus, and parahippocampal gyrus. Seizure diaries evaluated the final seizure remission between months 24 and 36, Verbal memory was evaluated at baseline and 24m with the Wechsler Memory Scale-Revised (WMS-R) and California Verbal Learning Test (CVLT). Patients were classified as having "significant improvement," "no change," and "significant impairment" based on relative change indices. Results: Thirteen high-dose and 17 low-dose patients were treated. Both groups showed significant reductions in seizures by 1 year after treatment. At the 36-month follow-up evaluation, 67% of patients were free of seizures for the prior 12 months (high dose: 10/13, 76.9%; low dose: 10/17, 58.8%). Use of steroids, headaches, and visual field defects did not differ by dose or seizure remission. The prevalence of verbal memory impairment was 15% (4/26 patients); none declined on more than one measure. The prevalence of significant verbal memory improvements was 12% (3/26). Interpretation: RS for unilateral mesial temporal lobe epilepsy offers seizure remission rates comparable with those reported previously for open surgery. There were no major safety concerns with high-dose RS compared with low-dose RS. Additional research is required to determine whether RS may be a treatment option for some patients with mesial temporal lobe epilepsy.

Original languageEnglish
Pages (from-to)167-175
Number of pages9
JournalAnnals of Neurology
Volume65
Issue number2
DOIs
StatePublished - Feb 2009

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Temporal Lobe Epilepsy
Radiosurgery
Seizures
Prospective Studies
Safety
Wechsler Scales
Verbal Learning
Parahippocampal Gyrus
Amygdala
Visual Fields
Headache
Hippocampus
Steroids
Morbidity
Therapeutics
Research

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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A multicenter, prospective pilot study of gamma knife radiosurgery for mesial temporal lobe epilepsy : Seizure response, adverse events, and verbal memory. / Barbaro, Nicholas; Quigg, Mark; Broshek, Donna K.; Ward, Mariann M.; Lamborn, Kathleen R.; Laxer, Kenneth D.; Larson, David A.; Dillon, William D.; Verhey, Lynn; Garcia, Paul; Steiner, Ladislau; Heck, Christine; Kondziolka, Douglas; Beach, Robert; Olivero, William; Witt, Thomas C.; Salanova, Vicenta; Goodman, Robert.

In: Annals of Neurology, Vol. 65, No. 2, 02.2009, p. 167-175.

Research output: Contribution to journalArticle

Barbaro, N, Quigg, M, Broshek, DK, Ward, MM, Lamborn, KR, Laxer, KD, Larson, DA, Dillon, WD, Verhey, L, Garcia, P, Steiner, L, Heck, C, Kondziolka, D, Beach, R, Olivero, W, Witt, TC, Salanova, V & Goodman, R 2009, 'A multicenter, prospective pilot study of gamma knife radiosurgery for mesial temporal lobe epilepsy: Seizure response, adverse events, and verbal memory', Annals of Neurology, vol. 65, no. 2, pp. 167-175. https://doi.org/10.1002/ana.21558
Barbaro, Nicholas ; Quigg, Mark ; Broshek, Donna K. ; Ward, Mariann M. ; Lamborn, Kathleen R. ; Laxer, Kenneth D. ; Larson, David A. ; Dillon, William D. ; Verhey, Lynn ; Garcia, Paul ; Steiner, Ladislau ; Heck, Christine ; Kondziolka, Douglas ; Beach, Robert ; Olivero, William ; Witt, Thomas C. ; Salanova, Vicenta ; Goodman, Robert. / A multicenter, prospective pilot study of gamma knife radiosurgery for mesial temporal lobe epilepsy : Seizure response, adverse events, and verbal memory. In: Annals of Neurology. 2009 ; Vol. 65, No. 2. pp. 167-175.
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AU - Ward, Mariann M.

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AU - Laxer, Kenneth D.

AU - Larson, David A.

AU - Dillon, William D.

AU - Verhey, Lynn

AU - Garcia, Paul

AU - Steiner, Ladislau

AU - Heck, Christine

AU - Kondziolka, Douglas

AU - Beach, Robert

AU - Olivero, William

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AU - Goodman, Robert

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N2 - Objective: The safety, efficacy, and morbidity of radiosurgery (RS) must be established before it can be offered as an alternative to open surgery for unilateral mesial temporal lobe epilepsy. We report the 3-year outcomes of a multicenter, prospective pilot study of RS. Methods: RS was randomized to 20 or 24Gy targeting the amygdala, hippocampus, and parahippocampal gyrus. Seizure diaries evaluated the final seizure remission between months 24 and 36, Verbal memory was evaluated at baseline and 24m with the Wechsler Memory Scale-Revised (WMS-R) and California Verbal Learning Test (CVLT). Patients were classified as having "significant improvement," "no change," and "significant impairment" based on relative change indices. Results: Thirteen high-dose and 17 low-dose patients were treated. Both groups showed significant reductions in seizures by 1 year after treatment. At the 36-month follow-up evaluation, 67% of patients were free of seizures for the prior 12 months (high dose: 10/13, 76.9%; low dose: 10/17, 58.8%). Use of steroids, headaches, and visual field defects did not differ by dose or seizure remission. The prevalence of verbal memory impairment was 15% (4/26 patients); none declined on more than one measure. The prevalence of significant verbal memory improvements was 12% (3/26). Interpretation: RS for unilateral mesial temporal lobe epilepsy offers seizure remission rates comparable with those reported previously for open surgery. There were no major safety concerns with high-dose RS compared with low-dose RS. Additional research is required to determine whether RS may be a treatment option for some patients with mesial temporal lobe epilepsy.

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