Padaczka skroniowa

Padaczka skroniowa
Leczenie

Padaczka skroniowa (TLE) jest jedną z najczęstszych form padaczki ogniskowej, dotykającą znaczną część pacjentów z padaczką częściową. Farmakoterapia stanowi pierwszą linię leczenia, z lekami takimi jak karbamazepina, okskarbazepina, lewetyracetam, lamotrygina, topiramat i inne, jednak około 30-40% pacjentów wykazuje oporność na leczenie farmakologiczne. W takich przypadkach rozważa się leczenie chirurgiczne, które w przypadku dobrze dobranych pacjentów, zwłaszcza ze stwardnieniem hipokampa, pozwala na uzyskanie wolności od napadów u 70-80% chorych. Standardowa lobektomia przednia skroniowa oraz inne techniki resekcyjne pozostają złotym standardem, a minimalnie inwazyjne metody, takie jak laseroterapia termiczna śródmiąższowa (LITT) czy radiochirurgia stereotaktyczna, oferują alternatywę z korzystnym profilem bezpieczeństwa. Neurostymulacja (VNS, RNS, DBS) jest opcją dla pacjentów niekwalifikujących się do zabiegów resekcyjnych, z umiarkowaną skutecznością w redukcji napadów (np. DBS w przednim jądrze wzgórza redukuje napady o 44,2%). Terapie dietetyczne, zwłaszcza dieta ketogeniczna, mogą przynieść redukcję napadów do 60%, choć są trudne w utrzymaniu.

Leczenie padaczki skroniowej – przegląd opcji terapeutycznych

Farmakoterapia padaczki skroniowej
Leczenie chirurgiczne padaczki skroniowej
Minimalnie inwazyjne techniki chirurgiczne
Neurostymulacja w leczeniu padaczki skroniowej
Terapie dietetyczne w leczeniu padaczki skroniowej
Terapie eksperymentalne i przyszłe kierunki leczenia
Kompleksowe podejście do leczenia padaczki skroniowej
Odstawianie leków po skutecznym leczeniu chirurgicznym

Czynniki wpływające na wybór metody leczenia

Czynniki prognostyczne w leczeniu farmakologicznym
Czynniki prognostyczne w leczeniu chirurgicznym
Opóźnienie w diagnostyce i leczeniu

Podsumowanie

Kolejne rozdziały

Leczenie padaczki skroniowej – przegląd opcji terapeutycznych

Padaczka skroniowa (TLE – Temporal Lobe Epilepsy) jest jedną z najczęstszych form padaczki ogniskowej, dotykającą ponad 400 000 osób spośród 1,2 miliona Amerykanów cierpiących na padaczkę częściową¹. Głównym celem leczenia padaczki skroniowej jest całkowite zniesienie napadów padaczkowych przy minimalnych działaniach niepożądanych²³. Niestety, padaczka skroniowa jest często oporna na leczenie, a około jednej trzeciej pacjentów nie osiąga kontroli napadów przy zastosowaniu wyłącznie farmakoterapii⁴⁵. Leczenie tej postaci padaczki może obejmować farmakoterapię, zabiegi chirurgiczne, neurostymulację oraz terapie dietetyczne, a ich wybór zależy od indywidualnych cech pacjenta oraz charakterystyki napadów⁶.

Farmakoterapia padaczki skroniowej

Leczenie farmakologiczne stanowi pierwszą linię terapii w padaczce skroniowej⁷. Obecnie dostępnych jest wiele leków przeciwpadaczkowych stosowanych w leczeniu TLE. Przez długi czas podstawowymi lekami stosowanymi w leczeniu napadów częściowych były cztery główne substancje: fenytoina, karbamazepina, walproinian i fenobarbital⁸. Jednak od 1995 roku FDA zatwierdziło wiele nowszych leków przeciwpadaczkowych, które znacznie poszerzyły możliwości terapeutyczne.

Do najczęściej stosowanych leków przeciwpadaczkowych w leczeniu padaczki skroniowej należą⁹¹⁰:

Karbamazepina (Tegretol) – działa na kanały sodowe podczas trwałego, szybkiego, powtarzalnego wyładowania¹¹
Okskarbazepina (zatwierdzony przez FDA jako monoterapia lub terapia dodatkowa w padaczce częściowej u dorosłych i dzieci w wieku 2-16 lat)¹²
Lewetyracetam (Keppra)¹³
Lamotrygina (Lamictal) – nowszy lek przeciwpadaczkowy zatwierdzony jako terapia dodatkowa i monoterapia krzyżowa w leczeniu napadów częściowych¹⁴
Topiramat (zatwierdzony przez FDA jako monoterapia lub terapia dodatkowa w leczeniu napadów częściowych i objawowych napadów uogólnionych)¹⁵
Briwaracetam¹⁶
Cenobamat¹⁷
Gabapentyna (zatwierdzony przez FDA jako terapia dodatkowa w leczeniu napadów częściowych)¹⁸
Lakozamid (wskazany w terapii dodatkowej napadów częściowych)¹⁹
Pregabalina (zatwierdzona w 2005 roku do stosowania jako terapia dodatkowa w napadach częściowych)²⁰
Rufinamid²¹
Walproinian²²
Zonisamid (zatwierdzony w Stanach Zjednoczonych do leczenia dodatkowego napadów częściowych)²³

Wybór początkowej terapii farmakologicznej zależy od wielu czynników, w tym profilu działań niepożądanych, schematu dawkowania i chorób współistniejących²⁴. Monoterapia jest preferowanym podejściem, a dawkę każdego przepisanego leku należy zwiększać, aż do uzyskania kontroli napadów lub wystąpienia działań niepożądanych²⁵. W przypadku nieskuteczności jednego leku można spróbować monoterapii innym preparatem²⁶.

Ważne jest, aby pamiętać, że leki przeciwpadaczkowe mogą powodować działania niepożądane, takie jak zmęczenie, przyrost masy ciała i zawroty głowy²⁷. Mogą również wpływać na skuteczność innych przyjmowanych leków, w tym doustnych środków antykoncepcyjnych²⁸²⁹. Ponadto nowsze leki przeciwpadaczkowe mają ostrzeżenie dotyczące całej klasy leków wydane przez FDA odnośnie występowania myśli samobójczych, które pojawiło się po wystąpieniu 4 samobójstw wśród 40 000 pacjentów narażonych na działanie tych leków³⁰.

Międzynarodowa Liga Przeciwpadaczkowa w 2011 roku zdefiniowała padaczkę lekooporną jako niepowodzenie dwóch lub więcej odpowiednio dobranych i dawkowanych leków przeciwpadaczkowych w kontrolowaniu napadów³¹. Szacuje się, że około 30-40% pacjentów nie reaguje na leki przeciwpadaczkowe, co wymaga rozważenia innych metod terapeutycznych³².

Leczenie chirurgiczne padaczki skroniowej

Chirurgia resekcyjna jest uznawana za najskuteczniejszą metodę leczenia padaczki skroniowej opornej na leki³³. W dobrze dobranych przypadkach 70-80% pacjentów z lekooporną padaczką skroniową staje się wolnych od napadów po zabiegu chirurgicznym³⁴. Co więcej, badania wykazały, że chirurgia jest znacznie skuteczniejsza niż przedłużone leczenie farmakologiczne pod względem długoterminowych wyników³⁵.

Istnieje kilka rodzajów zabiegów chirurgicznych stosowanych w leczeniu padaczki skroniowej³⁶:

Standardowa lobektomia przednia skroniowa (usunięcie części płata skroniowego) – jest to najczęściej stosowany rodzaj zabiegu chirurgicznego³⁷
Lobektomia skroniowa przednio-przyśrodkowa
Selektywna amygdalohipokampektomia (usunięcie niewielkich fragmentów hipokampa i ciała migdałowatego zawierających ognisko padaczkowe)³⁸
Resekcja bieguna skroniowego

Leczenie chirurgiczne jest szczególnie skuteczne u pacjentów ze stwardnieniem przyśrodkowej części płata skroniowego³⁹⁴⁰. W przeprowadzonym prospektywnym randomizowanym badaniu kontrolowanym porównującym przednią lobektomię skroniową z terapią farmakologiczną w lekoopornej padaczce skroniowej, zabieg chirurgiczny był skuteczniejszy niż leczenie farmakologiczne – roczny okres bez napadów wystąpił u 58% osób po przedniej lobektomii skroniowej w porównaniu do 8% osób leczonych farmakologicznie⁴¹.

Warto podkreślić, że stan wolny od napadów po 2 latach od operacji jest predyktorem długoterminowego wyniku bez napadów⁴². U osób ze stwardnieniem hipokampa w płacie skroniowym tylko po jednej stronie mózgu, około 70% staje się wolnych od napadów po operacji⁴³.

Chirurgia resekcyjna jest ogólnie bezpieczna, a najczęstszym powikłaniem neurologicznym po takim zabiegu jest niewielki ubytek pola widzenia⁴⁴. Niemniej jednak, niektórzy lekarze nadal uważają lobektomię skroniową za procedurę ekstremalną, wskazując na ryzyko działań niepożądanych, w tym utraty pamięci, zaburzeń widzenia i zmian emocjonalnych związanych z usunięciem tkanki mózgowej⁴⁵. Jednak takie skutki uboczne są minimalizowane przez staranny dobór pacjentów i szereg testów neurologicznych wskazujących, gdzie można dokonać resekcji, aby zminimalizować wpływ na funkcje neurologiczne⁴⁶.

Minimalnie inwazyjne techniki chirurgiczne

Postępy w zrozumieniu sieci padaczkowych poprawiły zdolność lepszego definiowania strefy padaczkorodnej u pacjentów z padaczką⁴⁷. Dążenie do przerwania sieci padaczkowych przy jak najmniejszej możliwej zmianie chirurgicznej doprowadziło do rozwoju minimalnie inwazyjnych technik chirurgicznych w leczeniu padaczki⁴⁸:

Radiochirurgia stereotaktyczna (SRS) – wykorzystująca nóż gamma i Cyberknife dostarcza promieniowanie jonizujące do ogniska przyśrodkowych struktur skroniowych w padaczce skroniowej; wykazano porównywalną pooperacyjną wolność od napadów w porównaniu do chirurgii inwazyjnej⁴⁹
Stereoelektroencefalografia (SEEG) – kierowana termokoagulacja⁵⁰
Laseroterapia termiczna śródmiąższowa (LITT) – w tej technice laser, kierowany przez MRI, niszczy obszar tkanki wywołujący napady⁵¹⁵²
Ablacja zogniskowanym ultradźwiękiem pod kontrolą MRI (FUS)⁵³

Metody te stanowią obiecujące nowe rozwiązania i są stosowane jako alternatywa dla standardowej chirurgii resekcyjnej⁵⁴. Leczenie laserowe jest szczególnie interesujące, ponieważ jest mniej inwazyjne niż resekcja (chociaż nadal wymaga znieczulenia ogólnego i umieszczenia sondy w obszarze mózgu, który ma być poddany ablacji)⁵⁵. Z perspektywy pacjenta, procedury te są wygodniejsze, mniej inwazyjne i bezpieczniejsze⁵⁶.

Co istotne, laseroterapia termiczna śródmiąższowa (LITT) zyskuje popularność jako minimalnie inwazyjna alternatywa dla otwartej lobektomii skroniowej przedniej⁵⁷. Charakteryzuje się stosunkowo korzystnym profilem bezpieczeństwa, z niewielką liczbą trwałych poważnych powikłań, a większość pacjentów jest wypisywana do domu w pierwszym dniu po operacji⁵⁸.

Neurostymulacja w leczeniu padaczki skroniowej

Neurostymulacja w leczeniu padaczki obejmuje stymulację nerwu błędnego (VNS), responsywną neurostymulację (RNS) i głęboką stymulację mózgu (DBS)⁵⁹. Metody te są zazwyczaj zarezerwowane dla pacjentów, którzy nie są kandydatami do zabiegu resekcyjnego lub nie chcą poddać się operacji⁶⁰. Neurostymulacja jest rozważana, gdy chirurgia lub ablacja laserowa jest zbyt trudna lub ryzykowna, często dlatego, że nie istnieje wyraźny punkt ogniskowy pochodzenia napadów lub nie można go zidentyfikować⁶¹.

Główne techniki neurostymulacji stosowane w leczeniu padaczki skroniowej to:

Stymulacja nerwu błędnego (VNS) – urządzenie umieszczone pod skórą klatki piersiowej stymuluje nerw błędny w szyi, wysyłając sygnały do mózgu, które zmniejszają napady⁶². VNS została zatwierdzona przez FDA w 1997 roku do leczenia opornej padaczki częściowej u pacjentów w wieku 4 lat i starszych⁶³.
Responsywna neurostymulacja (RNS) – urządzenie wszczepialne na powierzchni mózgu lub w tkance mózgowej może wykrywać aktywność napadową i dostarczać stymulację elektryczną do wykrytego obszaru, aby zatrzymać napad⁶⁴. RNS może być stosowana u pacjentów z dwuskroniowym ogniskiem napadowym lub ogniskami obejmującymi elokwentne regiony mózgu⁶⁵.
Głęboka stymulacja mózgu (DBS) – cienkie przewody zwane elektrodami są umieszczane w określonych obszarach mózgu, aby wytwarzać impulsy elektryczne. Impulsy te pomagają organizmowi zarządzać aktywnością mózgu, która powoduje napady⁶⁶. Elektrody są przymocowane do urządzenia podobnego do rozrusznika serca umieszczonego pod skórą klatki piersiowej⁶⁷.

Skuteczność DBS okazała się zależeć od lokalizacji ognisk napadowych. W badaniu podłużnym, w którym stymulowano przednie jądro wzgórza wśród osób z padaczką, osoby z ogniskiem napadowym w płacie skroniowym wykazały większą medianę redukcji napadów (44,2%) w porównaniu z 21,8% redukcji u osób otrzymujących leczenie kontrolne⁶⁸.

W większości badań stymulacja hipokampa miała zachęcające wyniki, przy czym ponad 50% uczestników stało się wolnych od napadów. Jednakże pacjenci z TLE ze stwardnieniem hipokampa mieli mniej korzystne wyniki niż ci bez stwardnienia hipokampa⁶⁹.

Warto zauważyć, że stopy całkowitego uwolnienia od napadów są niższe niż w przypadku resekcji czy ablacji laserowej, a większość pacjentów kontynuuje również przyjmowanie leków w celu leczenia napadów⁷⁰. Wszczepione urządzenie działa jak ściemniacz, który zmniejsza intensywność i częstotliwość napadów, a czasami zatrzymuje je, zanim się rozpoczną⁷¹.

Terapie dietetyczne w leczeniu padaczki skroniowej

Terapie dietetyczne mogą być skuteczną opcją w leczeniu padaczki opornej na leki. Najczęściej stosowaną dietą w leczeniu padaczki skroniowej jest dieta ketogeniczna⁷². Jest to dieta wysokotłuszczowa i niskowęglowodanowa, która indukuje tworzenie ciał ketonowych⁷³. Stosowanie diety ketogenicznej może poprawić kontrolę napadów⁷⁴, jednak może być ona trudna do przestrzegania, ponieważ pozwala na bardzo ograniczoną liczbę produktów⁷⁵.

Oprócz klasycznej diety ketogenicznej, w leczeniu padaczki stosowane mogą być również:

Dieta Atkinsa w wersji zmodyfikowanej⁷⁶
Diety o niskim indeksie glikemicznym⁷⁷

Zwolennicy diety ketogenicznej twierdzą, że zapewnia ona 10% wskaźnik wolności od napadów i wskaźniki redukcji napadów do 60%⁷⁸. Warianty diety wysokotłuszczowej i niskowęglowodanowej, takie jak dieta o niskim indeksie glikemicznym i zmodyfikowana dieta Atkinsa, mogą być mniej skuteczne, ale nie są tak restrykcyjne jak dieta ketogeniczna i mogą przynieść pewne korzyści⁷⁹.

Terapie eksperymentalne i przyszłe kierunki leczenia

Obecnie prowadzone są badania nad nowymi metodami leczenia padaczki skroniowej, w tym terapią genową i terapiami komórkowymi.

Terapia genowa

Zespoły badawcze z Charité – Universitätsmedizin Berlin i Medical University of Innsbruck opracowały nową koncepcję terapeutyczną leczenia padaczki skroniowej⁸⁰. Nowa metoda leczenia opiera się na ukierunkowanej terapii genowej, która polega na selektywnym dostarczaniu określonego genu do komórek nerwowych w obszarze mózgu, z którego pochodzą napady padaczkowe⁸¹.

Stymulacja o wysokiej częstotliwości komórek nerwowych, taka jak ta obserwowana na początku napadu, powoduje uwalnianie zmagazynowanych dynorfin⁸². Badacze byli w stanie wykazać na modelu zwierzęcym, że ta terapia genowa jest w stanie tłumić napady padaczkowe przez kilka miesięcy⁸³.

Dodatkowo firma uniQure rozpoczęła badanie kliniczne dotyczące terapii genowej oznaczonej jako AMT-260 w leczeniu przyśrodkowej padaczki skroniowej (MTLE)⁸⁴. Celem terapeutycznym jest obniżenie ekspresji receptorów kainianowych zawierających GluK2, które, jak się uważa, wywołują padaczkę, gdy są nieprawidłowo wyrażane w padaczkowym hipokampie⁸⁵.

Terapia komórkowa

Innym obiecującym kierunkiem jest terapia komórkowa. University of California San Diego Health stał się jednym z pierwszych systemów opieki zdrowotnej w kraju, który wstrzyknął komórki regeneracyjne do mózgu w celu leczenia napadów padaczkowych⁸⁶. Ta pierwsza eksperymentalna terapia komórkowa regeneracyjna, NRTX-1001, może zapewnić pacjentom z padaczką skroniową oporną na leki pierwszą niedestrukcyjną opcję potencjalnego wyleczenia napadów⁸⁷.

Eksperymentalna terapia komórkowa wszczepia zdrowe ludzkie komórki mózgowe do uszkodzonego płata skroniowego z nadzieją, że te nowe komórki zaczną nawiązywać połączenia w mózgu pacjenta, aby ostatecznie stworzyć zdrowszy płat skroniowy⁸⁸. Wstępne dane opublikowane w czerwcu wykazują ponad 90% redukcję częstotliwości napadów u pierwszego i drugiego pacjenta odpowiednio po roku i siedmiu miesiącach od leczenia⁸⁹.

NRTX-1001 to regeneracyjna terapia komórkowa wywodząca się z ludzkich pluripotencjalnych komórek macierzystych⁹⁰. Jest przeznaczona do integracji i unerwienia celu oraz zaprojektowana do trwałego wyciszenia aktywności napadowej w padaczkowym regionie mózgu⁹¹. Wstępne dane wskazują na obiecującą redukcję (95%) częstotliwości napadów przy kluczowym punkcie końcowym po roku od leczenia u pierwszego pacjenta, który otrzymał NRTX-1001, wraz z poprawą pamięci i brakiem napadów od siódmego miesiąca po leczeniu⁹².

Kompleksowe podejście do leczenia padaczki skroniowej

Oprócz zarządzania napadami, pacjenci z padaczką skroniową mogą mieć problemy poznawcze, współistniejące choroby psychiczne i problemy psychospołeczne⁹³. Kompleksowe podejście do leczenia osoby z padaczką skroniową musi uwzględniać deficyty poznawcze i współistniejące choroby psychiczne, które często towarzyszą temu schorzeniu⁹⁴.

Wszyscy dorośli z padaczką powinni mieć kompleksowy plan opieki, który powinien obejmować kwestie związane ze stylem życia, a także kwestie medyczne⁹⁵. Pielęgniarki specjalizujące się w padaczce powinny stanowić integralną część sieci opieki⁹⁶.

Ważne jest, aby pacjenci z padaczką byli prowadzeni przez multidyscyplinarny zespół specjalistów. Każdy pacjent powinien mieć przynajmniej raz w roku kontrolę stanu zdrowia⁹⁷. Zespół medyczny powinien opracować wspólnie z pacjentem plan opieki, który będzie zawierał szczegółowe informacje na temat potrzebnej opieki i wsparcia⁹⁸. Plan ten będzie również informował rodzinę lub opiekunów, co robić, gdy u pacjenta wystąpi napad⁹⁹.

Odstawianie leków po skutecznym leczeniu chirurgicznym

Istnieje możliwość odstawienia leków przeciwpadaczkowych u pacjentów, którzy osiągnęli długotrwałą remisję napadów po zabiegu chirurgicznym. W jednym z badań zastosowano protokół odstawiania leków u pacjentów po dwóch latach obserwacji¹⁰⁰.

Pacjenci z klinicznie oporną padaczką skroniową poddani leczeniu chirurgicznemu, którzy stali się wolni od napadów przez okres dwóch lat i mieli seryjne badania EEG bez wyładowań padaczkowych, byli kandydatami do poddania się protokołowi odstawiania leków przeciwpadaczkowych¹⁰¹. Odstawianie przeprowadzano stopniowo, a dawkę leku zmniejszano o 25% całkowitej dawki w okresie pięciu okresów półtrwania leku¹⁰².

W ostatniej obserwacji 57,81% pacjentów było wolnych od napadów bez leków przeciwpadaczkowych, u 6,25% odstawianie zostało przerwane, ponieważ w EEG pojawiły się wyładowania padaczkowe, a u 35,94% wystąpiły napady¹⁰³. Protokół ten wydaje się być bezpieczny, z wysokim wskaźnikiem nawrotów napadów, ale gdy leki przeciwpadaczkowe zostały w pełni przywrócone, zdecydowana większość pacjentów ponownie stała się wolna od napadów¹⁰⁴.

Czynniki wpływające na wybór metody leczenia

Wybór odpowiedniej metody leczenia padaczki skroniowej zależy od wielu czynników, w tym charakterystyki napadów, obrazu klinicznego oraz preferencji pacjenta.

Czynniki prognostyczne w leczeniu farmakologicznym

Wczesna monoterapia odgrywa kluczową rolę w leczeniu padaczki skroniowej. Badania wykazały, że skuteczna wczesna monoterapia jest niezależnym predyktorem dobrego efektu terapeutycznego u wszystkich pacjentów z TLE (OR: 0,16; 95% CI: 0,04–0,66; P=0,007)¹⁰⁵.

Niestety, tylko około 23,2% pacjentów z TLE osiąga wolność od napadów po leczeniu samymi lekami przeciwpadaczkowymi, podczas gdy pozostałe 76,8% pacjentów jest diagnozowanych jako padaczka lekooporna¹⁰⁶.

Czynniki prognostyczne w leczeniu chirurgicznym

Analiza wieloczynnikowej regresji logistycznej wykazała, że predyktorami dobrego rokowania u pacjentów z lekooporną padaczką po zabiegu chirurgicznym są:

jednostronne pochodzenie wyładowań w elektroencefalogramie (EEG, OR = 0,20, 95% CI: 0,06–0,74, P = 0,016)¹⁰⁷
brak wtórnych uogólnionych napadów toniczno-klonicznych (GTCS, OR = 0,08, 95% CI: 0,01–0,67, P = 0,002)¹⁰⁸
brak konieczności stosowania elektrody podtwardówkowej (OR = 15,4, 95% CI: 1,36–174,38, P = 0,027)¹⁰⁹

Ponadto wyniki chirurgicznego leczenia są szczególnie dobre, jeśli pacjent ma stwardnienie hipokampa¹¹⁰. Ważne jest jednak, aby pacjenci ci byli kierowani na ocenę chirurgiczną wcześnie w przebiegu choroby, ponieważ długi czas trwania choroby zmniejsza prawdopodobieństwo dobrego wyniku¹¹¹.

Opóźnienie w diagnostyce i leczeniu

Pomimo wysokiego globalnego obciążenia padaczką, często występuje opóźnienie w początkowej diagnozie, nawet w krajach rozwiniętych¹¹². Co istotne, średnio występuje opóźnienie ponad 20 lat między początkową diagnozą a chirurgicznym leczeniem osób, u których optymalne stosowanie leków przeciwpadaczkowych nie przyniosło efektu¹¹³.

Szybkie skierowanie do kompleksowych ośrodków leczenia padaczki umożliwia szczegółową ocenę i rozważenie wielu alternatywnych planów leczenia¹¹⁴. Idealnym celem leczenia padaczki jest całkowita wolność od napadów i brak jakichkolwiek działań niepożądanych¹¹⁵.

Podsumowanie

Leczenie padaczki skroniowej wymaga kompleksowego podejścia i indywidualnego doboru metod terapeutycznych. Farmakoterapia stanowi pierwszą linię leczenia, ale u około jednej trzeciej pacjentów napady padaczkowe są oporne na leki. W takich przypadkach należy rozważyć metody niefarmakologiczne, w tym leczenie chirurgiczne, neurostymulację i terapie dietetyczne.

Leczenie chirurgiczne, szczególnie lobektomia skroniowa, jest najskuteczniejszą metodą terapii padaczki skroniowej opornej na leki, z wysokim odsetkiem pacjentów uzyskujących wolność od napadów. Rozwój minimalnie inwazyjnych technik chirurgicznych, takich jak laseroterapia termiczna śródmiąższowa (LITT), oferuje alternatywę dla tradycyjnych metod resekcyjnych.

Neurostymulacja, w tym stymulacja nerwu błędnego (VNS), responsywna neurostymulacja (RNS) i głęboka stymulacja mózgu (DBS), stanowi opcję dla pacjentów niebędących kandydatami do leczenia chirurgicznego. Terapie dietetyczne, szczególnie dieta ketogeniczna, mogą również przynieść korzyści niektórym pacjentom.

Obiecujące kierunki badań, takie jak terapia genowa i terapie komórkowe, mogą w przyszłości rozszerzyć możliwości terapeutyczne. Ważne jest, aby pacjenci z padaczką skroniową oporną na leczenie byli szybko kierowani do specjalistycznych ośrodków leczenia padaczki w celu kompleksowej oceny i rozważenia wszystkich dostępnych opcji terapeutycznych.

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Diagnosis and treatment of temporal lobe epilepsy – PubMed
https://pubmed.ncbi.nlm.nih.gov/16397445/
Of the 1,200,000 Americans with partial epilepsy, temporal lobe epilepsy (TLE) occurs in more than 400,000. […] TLE is treated with medications, resective surgery, and vagus nerve stimulation. […] Epilepsy surgery should be considered in all patients with refractory partial epilepsy.
#2 Temporal lobe seizure – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/temporal-lobe-seizure/diagnosis-treatment/drc-20378220
Not everyone who has a seizure has another one. Your healthcare professional may decide not to start treatment until you’ve had more than one. […] Seizure treatment aims to find the best therapy to stop your seizures with the fewest side effects. […] Many medicines treat temporal lobe seizures. But many people can’t manage seizures fully with medicines alone. Side effects are common. They can include tiredness, weight gain and dizziness. […] Discuss possible side effects with your healthcare professional when thinking about treatments. Also ask what effect your seizure medicines may have on other medicines you take. For instance, some antiseizure medicines can affect how well birth control pills work. […] Following a ketogenic diet can improve seizure management. A ketogenic diet is high in fat and very low in carbohydrates. But it can be hard to follow because it allows only a very limited number of foods.
#3 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy
https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/
The ideal treatment goal for epilepsy includes complete seizure freedom and the absence of any side effects. […] Appropriate and targeted treatment (eg, surgical resection, neuromodulation, a combination of both, and continued ASM therapy) requires a multidisciplinary approach. […] Prompt referral to comprehensive epilepsy centers allows such detailed evaluation and consideration of a multiplicity of alternative treatment plans.
#4 Temporal Lobe Epilepsy: Causes, Symptoms, and Treatment
https://www.healthline.com/health/temporal-lobe-epilepsy
Most people with temporal lobe epilepsy respond well to anti-epilepsy drugs. However, these drugs come with various side effects, including tiredness, weight gain, and dizziness. They also may interfere with other medications, such as oral contraceptives. […] At least one-third of people with temporal lobe epilepsy do not respond to medication alone and require other medical interventions to treat their disorder. Surgery is another common treatment for people with temporal lobe epilepsy. Its used to eliminate or reduce the number of seizures a person experiences. All surgeries carry risks, however, and an unsuccessful surgery may actually create neurological problems. […] Other types of medical interventions used to treat temporal lobe epilepsy include: […] Vagus nerve stimulation: A stimulating device is surgically implanted into the chest under the collarbone with wires from the stimulator connecting to the vagus nerve in the neck may help reduce the frequency and intensity of seizures.
#5 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy
https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/
The average 20-year delay of referral to epilepsy centers can be improved. […] Approximately, one-third of people with epilepsy are estimated to have drug-resistant epilepsy (DRE). […] Despite the high global burden of epilepsy, there is often a delay in initial diagnosis, even in developed countries. […] Notably, on average there is a delay of more than 20 years between initial diagnosis and surgical management of people who are failed by optimal use of ASMs. […] After treatment with ASMs, TS had a reduction in her seizure burden, but did not achieve seizure freedom. […] JF’s evaluation at our level 4 epilepsy center with videoEEG revealed seizures arising from his left temporal lobe. […] Having been failed by 2 ASMs, JF’s seizures were identified as DRE, and further presurgical workup was initiated.
#6 Temporal Lobe Epilepsy (TLE): Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17778-temporal-lobe-seizures
A healthcare provider may recommend medications or surgery to manage seizures. […] Treatment for temporal lobe epilepsy may include: Antiseizure medications, Epilepsy surgery, Neurostimulation. […] Many antiseizure medications are available to treat temporal lobe seizures, including: Brivaracetam, Cenobamate, Carbamazepine, Gabapentin, Lamotrigine, Lacosamide, Levetiracetam, Oxcarbazepine, Pregabalin, Rufinamide, Topiramate, Valproate, Zonisamide. […] Your healthcare provider may consider surgery if antiseizure medications aren’t successful or if a tumor causes epilepsy symptoms. […] A temporal lobectomy (removal of part of your temporal lobe) is the most common type of surgery. […] Neurostimulation devices may be an option if medications aren’t successful or surgery isn’t a safe option.
#7 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
The first-line therapy for MTLE includes the initiation of appropriately chosen antiepileptic drug (AED) treatment. For patients with MTLE, the most effective AEDs are those used to treat focal epilepsies such as carbamazepine, oxcarbazepine, levetiracetam, lamotrigine, and topiramate. These agents can be monotherapy or, more often, in combination to achieve adequate seizure freedom. However, it is well known that patients with MTLE often have an inadequate response to antiepileptic drug therapy. Some patients who initially respond may also end up becoming medically refractory within a few years. Non-pharmacological approaches eventually play an essential role in the management of patients with medically refractory or drug-resistant MTLE. These include both surgical and neurostimulation approaches.
#8 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
For the longest time, 4 principal medications were used for partial seizures: phenytoin, carbamazepine, valproate, and phenobarbital. However, a number of newer medications have been approved by the FDA since 1995. Some of these newer AEDs are approved as monotherapy, but how they compare with the older AEDs is not known. […] The initial choice of medication depends on many factors, including side-effect profile, dosage schedule, and comorbid conditions. The major VA trials did not show any significant difference in seizure control among the 4 older AEDs. Adverse effects were greater with phenobarbital and with primidone and least with carbamazepine. […] Single-drug therapy is the goal, and the dosage of each medication prescribed should be increased until either seizures are controlled or adverse effects occur.
#9 Temporal Lobe Epilepsy (TLE): Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17778-temporal-lobe-seizures
A healthcare provider may recommend medications or surgery to manage seizures. […] Treatment for temporal lobe epilepsy may include: Antiseizure medications, Epilepsy surgery, Neurostimulation. […] Many antiseizure medications are available to treat temporal lobe seizures, including: Brivaracetam, Cenobamate, Carbamazepine, Gabapentin, Lamotrigine, Lacosamide, Levetiracetam, Oxcarbazepine, Pregabalin, Rufinamide, Topiramate, Valproate, Zonisamide. […] Your healthcare provider may consider surgery if antiseizure medications aren’t successful or if a tumor causes epilepsy symptoms. […] A temporal lobectomy (removal of part of your temporal lobe) is the most common type of surgery. […] Neurostimulation devices may be an option if medications aren’t successful or surgery isn’t a safe option.
#10 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
The first-line therapy for MTLE includes the initiation of appropriately chosen antiepileptic drug (AED) treatment. For patients with MTLE, the most effective AEDs are those used to treat focal epilepsies such as carbamazepine, oxcarbazepine, levetiracetam, lamotrigine, and topiramate. These agents can be monotherapy or, more often, in combination to achieve adequate seizure freedom. However, it is well known that patients with MTLE often have an inadequate response to antiepileptic drug therapy. Some patients who initially respond may also end up becoming medically refractory within a few years. Non-pharmacological approaches eventually play an essential role in the management of patients with medically refractory or drug-resistant MTLE. These include both surgical and neurostimulation approaches.
#11 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
The new AEDs have a class-wide warning about suicidal ideation mandated by the FDA, which arose from 4 suicides amongst 40,000 patients exposed to AEDs. The patient should be evaluated for mood changes, which may need treatment. […] These agents prevent seizure recurrence and terminate clinical and electrical seizure activity. […] Carbamazepine affects sodium channels during sustained, rapid, repetitive firing. […] Phenytoin is one of oldest drugs known for treatment of seizures. […] This anticonvulsant is effective for a broad spectrum of seizure types; it is believed to exert its anticonvulsant effect by increasing gamma-aminobutyric acid (GABA) levels in the brain. […] Lamotrigine is a newer AED; it was approved as an adjunctive therapy and a crossover monotherapy for partial seizures.
#12 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
Gabapentin is approved by the FDA as an adjunctive therapy for partial seizures. […] Topiramate is approved by the FDA as a monotherapy or an adjunctive therapy for partial seizures and symptomatic generalized seizures. […] Tiagabine can be used as an add-on therapy for partial seizures. […] Zonisamide is approved in the United States for adjunctive use in the treatment of partial seizures. […] Oxcarbazepine is approved by the FDA as a monotherapy and as an adjunctive therapy for partial epilepsy in adults and children aged 2-16 years. […] Levetiracetam was approved by the FDA in 1999 as an add-on therapy for partial seizures. […] Felbamate is approved for medically refractory partial seizures and Lennox-Gastaut syndrome. […] Pregabalin was approved in 2005 for adjunctive use in partial seizures in adults.
#13 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
Gabapentin is approved by the FDA as an adjunctive therapy for partial seizures. […] Topiramate is approved by the FDA as a monotherapy or an adjunctive therapy for partial seizures and symptomatic generalized seizures. […] Tiagabine can be used as an add-on therapy for partial seizures. […] Zonisamide is approved in the United States for adjunctive use in the treatment of partial seizures. […] Oxcarbazepine is approved by the FDA as a monotherapy and as an adjunctive therapy for partial epilepsy in adults and children aged 2-16 years. […] Levetiracetam was approved by the FDA in 1999 as an add-on therapy for partial seizures. […] Felbamate is approved for medically refractory partial seizures and Lennox-Gastaut syndrome. […] Pregabalin was approved in 2005 for adjunctive use in partial seizures in adults.
#14 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
The new AEDs have a class-wide warning about suicidal ideation mandated by the FDA, which arose from 4 suicides amongst 40,000 patients exposed to AEDs. The patient should be evaluated for mood changes, which may need treatment. […] These agents prevent seizure recurrence and terminate clinical and electrical seizure activity. […] Carbamazepine affects sodium channels during sustained, rapid, repetitive firing. […] Phenytoin is one of oldest drugs known for treatment of seizures. […] This anticonvulsant is effective for a broad spectrum of seizure types; it is believed to exert its anticonvulsant effect by increasing gamma-aminobutyric acid (GABA) levels in the brain. […] Lamotrigine is a newer AED; it was approved as an adjunctive therapy and a crossover monotherapy for partial seizures.
#15 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
Gabapentin is approved by the FDA as an adjunctive therapy for partial seizures. […] Topiramate is approved by the FDA as a monotherapy or an adjunctive therapy for partial seizures and symptomatic generalized seizures. […] Tiagabine can be used as an add-on therapy for partial seizures. […] Zonisamide is approved in the United States for adjunctive use in the treatment of partial seizures. […] Oxcarbazepine is approved by the FDA as a monotherapy and as an adjunctive therapy for partial epilepsy in adults and children aged 2-16 years. […] Levetiracetam was approved by the FDA in 1999 as an add-on therapy for partial seizures. […] Felbamate is approved for medically refractory partial seizures and Lennox-Gastaut syndrome. […] Pregabalin was approved in 2005 for adjunctive use in partial seizures in adults.
#16 Temporal Lobe Epilepsy (TLE): Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17778-temporal-lobe-seizures
A healthcare provider may recommend medications or surgery to manage seizures. […] Treatment for temporal lobe epilepsy may include: Antiseizure medications, Epilepsy surgery, Neurostimulation. […] Many antiseizure medications are available to treat temporal lobe seizures, including: Brivaracetam, Cenobamate, Carbamazepine, Gabapentin, Lamotrigine, Lacosamide, Levetiracetam, Oxcarbazepine, Pregabalin, Rufinamide, Topiramate, Valproate, Zonisamide. […] Your healthcare provider may consider surgery if antiseizure medications aren’t successful or if a tumor causes epilepsy symptoms. […] A temporal lobectomy (removal of part of your temporal lobe) is the most common type of surgery. […] Neurostimulation devices may be an option if medications aren’t successful or surgery isn’t a safe option.
#17 Temporal Lobe Epilepsy (TLE): Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17778-temporal-lobe-seizures
A healthcare provider may recommend medications or surgery to manage seizures. […] Treatment for temporal lobe epilepsy may include: Antiseizure medications, Epilepsy surgery, Neurostimulation. […] Many antiseizure medications are available to treat temporal lobe seizures, including: Brivaracetam, Cenobamate, Carbamazepine, Gabapentin, Lamotrigine, Lacosamide, Levetiracetam, Oxcarbazepine, Pregabalin, Rufinamide, Topiramate, Valproate, Zonisamide. […] Your healthcare provider may consider surgery if antiseizure medications aren’t successful or if a tumor causes epilepsy symptoms. […] A temporal lobectomy (removal of part of your temporal lobe) is the most common type of surgery. […] Neurostimulation devices may be an option if medications aren’t successful or surgery isn’t a safe option.
#18 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
Gabapentin is approved by the FDA as an adjunctive therapy for partial seizures. […] Topiramate is approved by the FDA as a monotherapy or an adjunctive therapy for partial seizures and symptomatic generalized seizures. […] Tiagabine can be used as an add-on therapy for partial seizures. […] Zonisamide is approved in the United States for adjunctive use in the treatment of partial seizures. […] Oxcarbazepine is approved by the FDA as a monotherapy and as an adjunctive therapy for partial epilepsy in adults and children aged 2-16 years. […] Levetiracetam was approved by the FDA in 1999 as an add-on therapy for partial seizures. […] Felbamate is approved for medically refractory partial seizures and Lennox-Gastaut syndrome. […] Pregabalin was approved in 2005 for adjunctive use in partial seizures in adults.
#19 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
Rufinamide is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome. […] Ethotoin may act in the motor cortex where it may inhibit the spread of seizure activity. […] Vigabatrin is FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia and as adjunctive therapy in partial-onset seizures. […] Lacosamide is indicated for adjunctive therapy for partial-onset seizures.
#20 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
Gabapentin is approved by the FDA as an adjunctive therapy for partial seizures. […] Topiramate is approved by the FDA as a monotherapy or an adjunctive therapy for partial seizures and symptomatic generalized seizures. […] Tiagabine can be used as an add-on therapy for partial seizures. […] Zonisamide is approved in the United States for adjunctive use in the treatment of partial seizures. […] Oxcarbazepine is approved by the FDA as a monotherapy and as an adjunctive therapy for partial epilepsy in adults and children aged 2-16 years. […] Levetiracetam was approved by the FDA in 1999 as an add-on therapy for partial seizures. […] Felbamate is approved for medically refractory partial seizures and Lennox-Gastaut syndrome. […] Pregabalin was approved in 2005 for adjunctive use in partial seizures in adults.
#21 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
Rufinamide is indicated for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome. […] Ethotoin may act in the motor cortex where it may inhibit the spread of seizure activity. […] Vigabatrin is FDA approved for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia and as adjunctive therapy in partial-onset seizures. […] Lacosamide is indicated for adjunctive therapy for partial-onset seizures.
#22 Temporal Lobe Epilepsy (TLE): Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17778-temporal-lobe-seizures
A healthcare provider may recommend medications or surgery to manage seizures. […] Treatment for temporal lobe epilepsy may include: Antiseizure medications, Epilepsy surgery, Neurostimulation. […] Many antiseizure medications are available to treat temporal lobe seizures, including: Brivaracetam, Cenobamate, Carbamazepine, Gabapentin, Lamotrigine, Lacosamide, Levetiracetam, Oxcarbazepine, Pregabalin, Rufinamide, Topiramate, Valproate, Zonisamide. […] Your healthcare provider may consider surgery if antiseizure medications aren’t successful or if a tumor causes epilepsy symptoms. […] A temporal lobectomy (removal of part of your temporal lobe) is the most common type of surgery. […] Neurostimulation devices may be an option if medications aren’t successful or surgery isn’t a safe option.
#23 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
Gabapentin is approved by the FDA as an adjunctive therapy for partial seizures. […] Topiramate is approved by the FDA as a monotherapy or an adjunctive therapy for partial seizures and symptomatic generalized seizures. […] Tiagabine can be used as an add-on therapy for partial seizures. […] Zonisamide is approved in the United States for adjunctive use in the treatment of partial seizures. […] Oxcarbazepine is approved by the FDA as a monotherapy and as an adjunctive therapy for partial epilepsy in adults and children aged 2-16 years. […] Levetiracetam was approved by the FDA in 1999 as an add-on therapy for partial seizures. […] Felbamate is approved for medically refractory partial seizures and Lennox-Gastaut syndrome. […] Pregabalin was approved in 2005 for adjunctive use in partial seizures in adults.
#24 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
For the longest time, 4 principal medications were used for partial seizures: phenytoin, carbamazepine, valproate, and phenobarbital. However, a number of newer medications have been approved by the FDA since 1995. Some of these newer AEDs are approved as monotherapy, but how they compare with the older AEDs is not known. […] The initial choice of medication depends on many factors, including side-effect profile, dosage schedule, and comorbid conditions. The major VA trials did not show any significant difference in seizure control among the 4 older AEDs. Adverse effects were greater with phenobarbital and with primidone and least with carbamazepine. […] Single-drug therapy is the goal, and the dosage of each medication prescribed should be increased until either seizures are controlled or adverse effects occur.
#25 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
For the longest time, 4 principal medications were used for partial seizures: phenytoin, carbamazepine, valproate, and phenobarbital. However, a number of newer medications have been approved by the FDA since 1995. Some of these newer AEDs are approved as monotherapy, but how they compare with the older AEDs is not known. […] The initial choice of medication depends on many factors, including side-effect profile, dosage schedule, and comorbid conditions. The major VA trials did not show any significant difference in seizure control among the 4 older AEDs. Adverse effects were greater with phenobarbital and with primidone and least with carbamazepine. […] Single-drug therapy is the goal, and the dosage of each medication prescribed should be increased until either seizures are controlled or adverse effects occur.
#26 Epilepsy in Adults (Causes, Symptoms, and Treatment)
https://patient.info/doctor/epilepsy-in-adults
Treatment should be with a single AED wherever possible. If the initial treatment is unsuccessful then monotherapy using another drug can be tried. […] If an AED has failed because of adverse effects or continued seizures, a second drug should be started and built up to an adequate or maximum tolerated dose and then the first drug should be tapered off slowly. […] Combination therapy should only be considered when attempts at monotherapy with AEDs have not resulted in seizure freedom. […] Epilepsy is resistant to drug treatment in a third of patients. […] If using carbamazepine, offer controlled-release carbamazepine preparations. […] AED therapy should only be started once the diagnosis of epilepsy is confirmed, except in exceptional circumstances. AED therapy should be initiated by a specialist.
#27 Temporal Lobe Epilepsy: Causes, Symptoms, and Treatment
https://www.healthline.com/health/temporal-lobe-epilepsy
Most people with temporal lobe epilepsy respond well to anti-epilepsy drugs. However, these drugs come with various side effects, including tiredness, weight gain, and dizziness. They also may interfere with other medications, such as oral contraceptives. […] At least one-third of people with temporal lobe epilepsy do not respond to medication alone and require other medical interventions to treat their disorder. Surgery is another common treatment for people with temporal lobe epilepsy. Its used to eliminate or reduce the number of seizures a person experiences. All surgeries carry risks, however, and an unsuccessful surgery may actually create neurological problems. […] Other types of medical interventions used to treat temporal lobe epilepsy include: […] Vagus nerve stimulation: A stimulating device is surgically implanted into the chest under the collarbone with wires from the stimulator connecting to the vagus nerve in the neck may help reduce the frequency and intensity of seizures.
#28 Temporal lobe seizure – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/temporal-lobe-seizure/diagnosis-treatment/drc-20378220
Not everyone who has a seizure has another one. Your healthcare professional may decide not to start treatment until you’ve had more than one. […] Seizure treatment aims to find the best therapy to stop your seizures with the fewest side effects. […] Many medicines treat temporal lobe seizures. But many people can’t manage seizures fully with medicines alone. Side effects are common. They can include tiredness, weight gain and dizziness. […] Discuss possible side effects with your healthcare professional when thinking about treatments. Also ask what effect your seizure medicines may have on other medicines you take. For instance, some antiseizure medicines can affect how well birth control pills work. […] Following a ketogenic diet can improve seizure management. A ketogenic diet is high in fat and very low in carbohydrates. But it can be hard to follow because it allows only a very limited number of foods.
#29 Temporal lobe seizure // Middlesex Health
https://middlesexhealth.org/learning-center/diseases-and-conditions/temporal-lobe-seizure
Responsive neurostimulation. Surgeons place a device on the brain or in brain tissue. The device can tell when seizure activity starts. It sends electrical stimulation to stop the seizure. […] Deep brain stimulation. Surgeons place thin wires called electrodes in certain areas of the brain to produce electrical impulses. The impulses help the body manage the brain activity that causes seizures. […] People who’ve had seizures can most often have healthy pregnancies. But some medicines used to treat seizures sometimes can cause health conditions that are present at birth. […] Some antiseizure medicines keep birth control from working as well. Check with your healthcare professional to see whether your medicine affects your birth control.
#30 Temporal Lobe Epilepsy Medication: Anticonvulsants
https://emedicine.medscape.com/article/1184509-medication
The new AEDs have a class-wide warning about suicidal ideation mandated by the FDA, which arose from 4 suicides amongst 40,000 patients exposed to AEDs. The patient should be evaluated for mood changes, which may need treatment. […] These agents prevent seizure recurrence and terminate clinical and electrical seizure activity. […] Carbamazepine affects sodium channels during sustained, rapid, repetitive firing. […] Phenytoin is one of oldest drugs known for treatment of seizures. […] This anticonvulsant is effective for a broad spectrum of seizure types; it is believed to exert its anticonvulsant effect by increasing gamma-aminobutyric acid (GABA) levels in the brain. […] Lamotrigine is a newer AED; it was approved as an adjunctive therapy and a crossover monotherapy for partial seizures.
#31 Gene Therapy for Temporal Lobe Epilepsy | Cleveland Clinic
https://my.clevelandclinic.org/podcasts/neuro-pathways/gene-therapy-for-temporal-lobe-epilepsy
Imad Najm, MD, explores why temporal lobe epilepsy is among the most challenging epilepsy types to treat and how gene therapy aims to overcome the challenges. […] For epileptologists, the goal is 100% seizure freedom and driving today’s research is the desire to achieve 100% seizure freedom for all patients. In this episode of Neuro Pathways, we’re specifically exploring the treatment options for patients with medically refractory temporal lobe epilepsy and the dawn of gene therapy. […] The International League Against Epilepsy back in 2011 made our job a little bit easier by defining what we may call pharmacoresistant or medically intractable epilepsy, which is the failure of two or more anti-seizure medications that are appropriately chosen and dosed to control the seizures. […] We are waiting too long.
#32 10 epilepsy treatments â from lowest to highest risk | Brain | UT Southwestern Medical Center
https://utswmed.org/medblog/epilepsy-treatments/
The first medication might not be effective or might cause intolerable side effects. […] Unfortunately, about 30 percent to 40 percent of patients do not respond to medications at all, and we must consider other therapies. […] Medical marijuana is a term that now refers to one of more than 80 chemical compounds found in the cannabis plant cannabidiol oil or CBD oil. […] The goal of medication clinical trials is to make sure the drugs are safe and effective. […] Neurostimulators deliver electrical stimulation to the brain. […] Treatment options include: High-dose steroids, Administering a collection of human antibodies through the veins, Plasma exchange to filter the blood of disease-causing antibodies, Other medications that suppress the overly active immune system. […] If epileptic seizures are coming from one specific region of the brain, and they cannot be stopped with medications or other therapies we have discussed, the patient can be a candidate for intracranial neurostimulation.
#33 Temporal Lobe Epilepsy Treatment & Management: Approach Considerations, Antiepileptic Therapy, Neurostimulation: VNS, RNS, DBS
https://emedicine.medscape.com/article/1184509-treatment
There are many AEDs used for seizure control in temporal lobe epilepsy. […] Neurostimulation is a treatment option if the patient is refractory and is not a good surgical resective candidate. Vagus nerve stimulation (VNS) was approved by the US Food and Drug Administration (FDA) in 1997 for the treatment of intractable partial epilepsy in patients aged 4 years and older. […] Temporal lobectomy is the definitive treatment for medically intractable temporal lobe epilepsy, as it has a high seizure-free rate. […] Seizure-free state at 2 years postoperatively is predictive of long-term seizure-free outcome. In well-selected cases, 70-80% of patients with refractory temporal lobe epilepsy become seizure free after surgery. […] The dietary therapy that can be tried for intractable epilepsy is the ketogenic diet or the Modified Atkins diet.
#34 Temporal Lobe Epilepsy Treatment & Management: Approach Considerations, Antiepileptic Therapy, Neurostimulation: VNS, RNS, DBS
https://emedicine.medscape.com/article/1184509-treatment
There are many AEDs used for seizure control in temporal lobe epilepsy. […] Neurostimulation is a treatment option if the patient is refractory and is not a good surgical resective candidate. Vagus nerve stimulation (VNS) was approved by the US Food and Drug Administration (FDA) in 1997 for the treatment of intractable partial epilepsy in patients aged 4 years and older. […] Temporal lobectomy is the definitive treatment for medically intractable temporal lobe epilepsy, as it has a high seizure-free rate. […] Seizure-free state at 2 years postoperatively is predictive of long-term seizure-free outcome. In well-selected cases, 70-80% of patients with refractory temporal lobe epilepsy become seizure free after surgery. […] The dietary therapy that can be tried for intractable epilepsy is the ketogenic diet or the Modified Atkins diet.
#35 Surgical Treatment for Temporal Lobe Epilepsy | AAFP
https://www.aafp.org/pubs/afp/issues/2002/0215/p708.html
Epilepsy affects five to 10 persons per 1,000 population in North America and is the second most common cause of mental health disability, especially among young adults. […] Surgical treatment of temporal lobe epilepsy (TLE) has the potential not only to control seizures, but to prevent untimely death. […] The authors conclude that resection of the temporal lobe in patients with appropriate brain lesions and a history of poor epileptic control while taking medications is associated with better control of seizures, less need for medication adjustments, and increased quality of life.
#36 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Surgical approaches for MTLE include open resection and other minimally invasive techniques. Standard open resective surgery is considered to be the most effective and safe treatment option for TLE with superiority to prolonged medical therapy in terms of long-term outcomes. Several surgical procedures have been employed, including standard anterior temporal lobectomy, anteromedial temporal lobectomy, selective amygdalohippocampectomy, and temporal pole resection. Resective therapy has demonstrated an excellent outcome, especially if done early. Surgical resection offers postoperative seizure freedom at two years in 60% to 80% of patients with drug-resistant MTLE, whereas longer-term follow-ups present less favorable results. Anterior temporal lobectomy is generally safe, and the most common neurologic complication following such resective epilepsy surgery is a minor visual field deficit.
#37 Temporal Lobe Epilepsy (TLE): Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/17778-temporal-lobe-seizures
A healthcare provider may recommend medications or surgery to manage seizures. […] Treatment for temporal lobe epilepsy may include: Antiseizure medications, Epilepsy surgery, Neurostimulation. […] Many antiseizure medications are available to treat temporal lobe seizures, including: Brivaracetam, Cenobamate, Carbamazepine, Gabapentin, Lamotrigine, Lacosamide, Levetiracetam, Oxcarbazepine, Pregabalin, Rufinamide, Topiramate, Valproate, Zonisamide. […] Your healthcare provider may consider surgery if antiseizure medications aren’t successful or if a tumor causes epilepsy symptoms. […] A temporal lobectomy (removal of part of your temporal lobe) is the most common type of surgery. […] Neurostimulation devices may be an option if medications aren’t successful or surgery isn’t a safe option.
#38 Epilepsy Treatment Options | Brain Institute | OHSU
https://www.ohsu.edu/brain-institute/epilepsy-treatment
A temporal lobectomy removes part of the lobe where seizures start. More than 85% of people who have a temporal lobectomy have improved seizure control. […] Anterior temporal lobectomy: This is the most common surgery to control seizures that do not respond to medications. […] Selective amygdalohippocampectomy: In SAH, your surgeon removes small portions of the hippocampus and amygdala (within the affected temporal lobe) containing a seizure focus. […] OHSU is one of only a few dozen centers in the country with laser interstitial thermal therapy. […] A lesionectomy is open surgery to remove a seizure focus caused by a lesion damaged or diseased brain tissue. […] OHSU is the only center in Oregon offering responsive neurostimulation, or RNS. […] Vagus nerve stimulation (VNS) consists of a device and wires that are implanted during a minimally invasive procedure.
#39 Temporal lobe epilepsy | Tidsskrift for Den norske legeforening
https://tidsskriftet.no/en/2023/01/clinical-review/temporal-lobe-epilepsy
The temporal lobes are the part of the brain most likely to give rise to epileptic seizures. […] For patients who have been diagnosed with hippocampal sclerosis and whose seizures cannot be controlled with drugs, epilepsy surgery may be a good treatment option. […] The aim of this article is to illustrate the varying manifestations of temporal lobe seizures, and to provide a reminder that epilepsy surgery can be a good treatment option for those who do not achieve adequate seizure control with medications. […] Medical options for the treatment of temporal lobe epilepsy include drugs such as lamotrigine, levetiracetam, carbamazepine and oxcarbazepine. […] If two different antiepileptic drugs both have inadequate effects, a non-pharmacological treatment method should be considered, primarily epilepsy surgery.
#40 Temporal lobe epilepsy | Tidsskrift for Den norske legeforening
https://tidsskriftet.no/en/2023/01/clinical-review/temporal-lobe-epilepsy
Two randomised trials and numerous observational studies have shown that in difficult-to-treat temporal lobe epilepsy, surgery is significantly more effective than continued medical treatment. […] The results of surgery are particularly good if the patient has hippocampal sclerosis. […] However, it is important that these patients are referred for surgical assessment early in the disease course, as a long disease duration reduces the likelihood of a good outcome. […] In Norway, epilepsy surgery has been centralised to Rikshospitalet and the National Centre for Epilepsy, both in Oslo. Here, potential candidates for surgery undergo comprehensive pre-operative testing with the aim of localising the epileptogenic network as precisely as possible. Interventions are personalised for each patient based on these findings.
#41 Temporal lobe epilepsy – Wikipedia
https://en.wikipedia.org/wiki/Temporal_lobe_epilepsy
In the field of neurology, temporal lobe epilepsy is an enduring brain disorder that causes unprovoked seizures from the temporal lobe. […] Anticonvulsant medications, epilepsy surgery, and dietary treatments may improve seizure control. […] Those with uncontrolled seizures despite treatment with multiple anticonvulsant medications have pharmacoresistant epilepsy, and they may require epilepsy surgery to achieve seizure control. […] Penfield and Flanigan first described anterior temporal lobectomy, partial surgical removal of the temporal lobe, for treatment of mesial temporal lobe epilepsy in 1950. […] In a prospective randomized controlled trial comparing anterior temporal lobectomy to medical therapy for pharmacoresistant temporal lobe epilepsy, surgery was more effective than medical therapy with 1-year seizure free outcome occurring in 58% of persons with anterior temporal lobectomy compared to 8% of persons with drug treatment.
#42 Temporal Lobe Epilepsy Treatment & Management: Approach Considerations, Antiepileptic Therapy, Neurostimulation: VNS, RNS, DBS
https://emedicine.medscape.com/article/1184509-treatment
There are many AEDs used for seizure control in temporal lobe epilepsy. […] Neurostimulation is a treatment option if the patient is refractory and is not a good surgical resective candidate. Vagus nerve stimulation (VNS) was approved by the US Food and Drug Administration (FDA) in 1997 for the treatment of intractable partial epilepsy in patients aged 4 years and older. […] Temporal lobectomy is the definitive treatment for medically intractable temporal lobe epilepsy, as it has a high seizure-free rate. […] Seizure-free state at 2 years postoperatively is predictive of long-term seizure-free outcome. In well-selected cases, 70-80% of patients with refractory temporal lobe epilepsy become seizure free after surgery. […] The dietary therapy that can be tried for intractable epilepsy is the ketogenic diet or the Modified Atkins diet.
#43 Temporal lobe epilepsy – Wikipedia
https://en.wikipedia.org/wiki/Temporal_lobe_epilepsy
Among those with intractable mesial temporal lobe epilepsy and hippocampal sclerosis, about 70% become seizure-free after epilepsy surgery. […] Magnetic resonance-guided laser interstitial thermal therapy, stereotactic radiosurgery, and stereotactic radiofrequency ablation are surgical methods that treat epilepsy by destroying the abnormal brain tissue that causes seizures. […] Neurostimulation may also improve seizure control. […] The vagus nerve stimulator (VNS) is surgically implanted in the chest, and delivers programmed electrical stimulation to the vagus nerve in the neck. […] The responsive neurostimulation device is implanted in the skull, monitors electrical brain activity for seizures, and responds to seizures with programmed electrical stimulation to one or two brain areas. […] Programmed deep brain stimulation of the anterior thalamic nucleus may treat seizures arising from more than 2 brain areas. […] The ketogenic diet and modified Atkins diet are additional temporal lobe epilepsy treatment options.
#44 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Surgical approaches for MTLE include open resection and other minimally invasive techniques. Standard open resective surgery is considered to be the most effective and safe treatment option for TLE with superiority to prolonged medical therapy in terms of long-term outcomes. Several surgical procedures have been employed, including standard anterior temporal lobectomy, anteromedial temporal lobectomy, selective amygdalohippocampectomy, and temporal pole resection. Resective therapy has demonstrated an excellent outcome, especially if done early. Surgical resection offers postoperative seizure freedom at two years in 60% to 80% of patients with drug-resistant MTLE, whereas longer-term follow-ups present less favorable results. Anterior temporal lobectomy is generally safe, and the most common neurologic complication following such resective epilepsy surgery is a minor visual field deficit.
#45 Temporal Lobe Epilepsy Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City
https://www.neurosurgery.columbia.edu/patient-care/conditions/temporal-lobe-epilepsy
Some physicians still consider temporal lobectomy an extreme procedure, citing the risks of side effects, including loss of memory, visual disturbances, and emotional change, associated with the removal of brain tissue. However, such side effects are minimized by careful patient selection and a battery of neurological tests that indicate where resection can be made to minimize effects on neurological function. Also, experts state that the portion of the brain being removed already is behaving abnormally, and therefore its removal does not usually have a profound detrimental effect on brain function.
#46 Temporal Lobe Epilepsy Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City
https://www.neurosurgery.columbia.edu/patient-care/conditions/temporal-lobe-epilepsy
Some physicians still consider temporal lobectomy an extreme procedure, citing the risks of side effects, including loss of memory, visual disturbances, and emotional change, associated with the removal of brain tissue. However, such side effects are minimized by careful patient selection and a battery of neurological tests that indicate where resection can be made to minimize effects on neurological function. Also, experts state that the portion of the brain being removed already is behaving abnormally, and therefore its removal does not usually have a profound detrimental effect on brain function.
#47 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Advances in our understanding of epileptic networks have improved our ability to define the epileptogenic zone in patients with epilepsy better. The aim of disrupting epileptic networks with the smallest possible surgical lesion has led to the development of minimally invasive surgical techniques for epilepsy. Minimally invasive techniques include stereotactic radiosurgery (SRS), stereotactic radiofrequency thermocoagulation (SRT), laser interstitial thermal therapy (LITT), and MRI-guided focused ultrasound ablation (FUS). SRS using gamma knife and Cyberknife deliver ionizing radiation to a focal target of mesial temporal structures in MTLE and have shown comparable postoperative seizure freedom when compared to invasive surgery. Similarly, stereo-EEG (SEEG) guided thermocoagulation and laser interstitial thermal therapy (LITT) have also shown promising new developments and have been employed as alternative options to standard resective surgery.
#48 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Advances in our understanding of epileptic networks have improved our ability to define the epileptogenic zone in patients with epilepsy better. The aim of disrupting epileptic networks with the smallest possible surgical lesion has led to the development of minimally invasive surgical techniques for epilepsy. Minimally invasive techniques include stereotactic radiosurgery (SRS), stereotactic radiofrequency thermocoagulation (SRT), laser interstitial thermal therapy (LITT), and MRI-guided focused ultrasound ablation (FUS). SRS using gamma knife and Cyberknife deliver ionizing radiation to a focal target of mesial temporal structures in MTLE and have shown comparable postoperative seizure freedom when compared to invasive surgery. Similarly, stereo-EEG (SEEG) guided thermocoagulation and laser interstitial thermal therapy (LITT) have also shown promising new developments and have been employed as alternative options to standard resective surgery.
#49 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Advances in our understanding of epileptic networks have improved our ability to define the epileptogenic zone in patients with epilepsy better. The aim of disrupting epileptic networks with the smallest possible surgical lesion has led to the development of minimally invasive surgical techniques for epilepsy. Minimally invasive techniques include stereotactic radiosurgery (SRS), stereotactic radiofrequency thermocoagulation (SRT), laser interstitial thermal therapy (LITT), and MRI-guided focused ultrasound ablation (FUS). SRS using gamma knife and Cyberknife deliver ionizing radiation to a focal target of mesial temporal structures in MTLE and have shown comparable postoperative seizure freedom when compared to invasive surgery. Similarly, stereo-EEG (SEEG) guided thermocoagulation and laser interstitial thermal therapy (LITT) have also shown promising new developments and have been employed as alternative options to standard resective surgery.
#50 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Advances in our understanding of epileptic networks have improved our ability to define the epileptogenic zone in patients with epilepsy better. The aim of disrupting epileptic networks with the smallest possible surgical lesion has led to the development of minimally invasive surgical techniques for epilepsy. Minimally invasive techniques include stereotactic radiosurgery (SRS), stereotactic radiofrequency thermocoagulation (SRT), laser interstitial thermal therapy (LITT), and MRI-guided focused ultrasound ablation (FUS). SRS using gamma knife and Cyberknife deliver ionizing radiation to a focal target of mesial temporal structures in MTLE and have shown comparable postoperative seizure freedom when compared to invasive surgery. Similarly, stereo-EEG (SEEG) guided thermocoagulation and laser interstitial thermal therapy (LITT) have also shown promising new developments and have been employed as alternative options to standard resective surgery.
#51 Temporal Lobe Epilepsy: Symptoms, Causes, Treatment, Outlook
https://resources.healthgrades.com/right-care/epilepsy/temporal-lobe-epilepsy
If two different medication regimens do not stop your seizures, you may be a candidate for surgery. A second reason for surgery is if a tumor is causing seizures. […] Surgery may stop all of your seizures if the cause is scarring of the hippocampus, according to the Epilepsy Foundation. […] Temporal lobectomy (removal of your temporal lobe) is the most common, safe, and effective surgery. […] A minimally invasive technique is laser ablation. An MRI guides a laser to remove the specific part of your brain that is causing the seizure. […] If medications do not work or stop working and you are not a candidate for surgery, another option is a nerve stimulator. […] A vagus nerve stimulator is implanted under the skin of your chest. The wires lead up to the vagus nerve in your neck. It sends brief electrical pulses to your nerve to decrease seizure activity. […] If medication or surgery do not stop seizures, nerve stimulation implants may help.
#52 Seizure Treatment: Major Advances in Epilepsy Surgery Cure More People > News > Yale Medicine
https://www.yalemedicine.org/news/seizure-treatment-epilepsy-surgery-advances-cure-more-people
Laser ablation to destroy the abnormal tissue: Laser ablation, also known as thermal ablation, is less invasive than resection (although it still uses general anesthesia and a probe placed into the brain in the area to be ablated). […] A third option, called neurostimulation (or neuromodulation), involves implanting devices in the body to control the seizures. […] Neurostimulation is considered when surgery or laser ablation is too difficult or risky, often because a clear focal point of seizure origin does not exist or cant be identified. […] An implanted device works like a dimmer switch that lessens the intensity and frequency of seizures and sometimes stops them before they start, Dr. Quraishi explains. […] The rate of complete freedom from seizures is lower than with resection or laser ablation, and most patients also continue to take medication to treat the seizures.
#53 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Advances in our understanding of epileptic networks have improved our ability to define the epileptogenic zone in patients with epilepsy better. The aim of disrupting epileptic networks with the smallest possible surgical lesion has led to the development of minimally invasive surgical techniques for epilepsy. Minimally invasive techniques include stereotactic radiosurgery (SRS), stereotactic radiofrequency thermocoagulation (SRT), laser interstitial thermal therapy (LITT), and MRI-guided focused ultrasound ablation (FUS). SRS using gamma knife and Cyberknife deliver ionizing radiation to a focal target of mesial temporal structures in MTLE and have shown comparable postoperative seizure freedom when compared to invasive surgery. Similarly, stereo-EEG (SEEG) guided thermocoagulation and laser interstitial thermal therapy (LITT) have also shown promising new developments and have been employed as alternative options to standard resective surgery.
#54 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Advances in our understanding of epileptic networks have improved our ability to define the epileptogenic zone in patients with epilepsy better. The aim of disrupting epileptic networks with the smallest possible surgical lesion has led to the development of minimally invasive surgical techniques for epilepsy. Minimally invasive techniques include stereotactic radiosurgery (SRS), stereotactic radiofrequency thermocoagulation (SRT), laser interstitial thermal therapy (LITT), and MRI-guided focused ultrasound ablation (FUS). SRS using gamma knife and Cyberknife deliver ionizing radiation to a focal target of mesial temporal structures in MTLE and have shown comparable postoperative seizure freedom when compared to invasive surgery. Similarly, stereo-EEG (SEEG) guided thermocoagulation and laser interstitial thermal therapy (LITT) have also shown promising new developments and have been employed as alternative options to standard resective surgery.
#55 Seizure Treatment: Major Advances in Epilepsy Surgery Cure More People > News > Yale Medicine
https://www.yalemedicine.org/news/seizure-treatment-epilepsy-surgery-advances-cure-more-people
Laser ablation to destroy the abnormal tissue: Laser ablation, also known as thermal ablation, is less invasive than resection (although it still uses general anesthesia and a probe placed into the brain in the area to be ablated). […] A third option, called neurostimulation (or neuromodulation), involves implanting devices in the body to control the seizures. […] Neurostimulation is considered when surgery or laser ablation is too difficult or risky, often because a clear focal point of seizure origin does not exist or cant be identified. […] An implanted device works like a dimmer switch that lessens the intensity and frequency of seizures and sometimes stops them before they start, Dr. Quraishi explains. […] The rate of complete freedom from seizures is lower than with resection or laser ablation, and most patients also continue to take medication to treat the seizures.
#56 Seizure Treatment: Major Advances in Epilepsy Surgery Cure More People > News > Yale Medicine
https://www.yalemedicine.org/news/seizure-treatment-epilepsy-surgery-advances-cure-more-people
Treatment, in general, is more comfortable, less invasive, and safer. […] Epilepsy surgery might be considered if two or more anti-seizure medications (without significant side effects) are tried and dont stop the seizures, giving the condition the classification of refractory epilepsy. The goal of surgery is to identify and target the area (or areas) in the brain causing the seizures and remove or otherwise disable it, without harming nearby areas that regulate important functions, such as speech or memory. […] When the brain tissue causing the seizures is identified, there are two types of surgery to eliminate it: Resection (or cutting out the tissue causing the seizures): This is the traditional surgical treatment. […] Several surgical procedures for epilepsy treatment were first developed at Yale, including one of the most commonly used resection techniques for removing parts of the temporal lobe, which is the most common area for seizure disorders.
#57 Multicenter study of laser interstitial thermal therapy for mesial temporal lobe epilepsy – VJNeurology
https://www.vjneurology.com/video/omdc9g5xuge-multicenter-study-of-laser-interstitial-thermal-therapy-for-mesial-temporal-lobe-epilepsy/
Patients with temporal lobe epilepsy have the option of anterior temporal lobectomy (ATL), an open surgical resection, with 60-80% rates of seizure freedom. […] Therefore, MRI-guided laser interstitial thermal therapy (laser ablation) is growing in popularity as a minimally invasive alternative to ATL. […] Importantly, laser ablation is an option for patients who prefer minimally invasive procedures, reducing barriers to patients undergoing surgery. […] This with a relatively favorable safety profile, so few permanent serious complications and most patients being discharged home post-operative day one. […] So laser ablation may be an option for these patients and reduce barriers to patients undergoing surgery. […] I would also add that one of the key findings that we found in addition is that patients who choose laser ablation first may still be candidates for open surgery if they fail.
#58 Multicenter study of laser interstitial thermal therapy for mesial temporal lobe epilepsy – VJNeurology
https://www.vjneurology.com/video/omdc9g5xuge-multicenter-study-of-laser-interstitial-thermal-therapy-for-mesial-temporal-lobe-epilepsy/
Patients with temporal lobe epilepsy have the option of anterior temporal lobectomy (ATL), an open surgical resection, with 60-80% rates of seizure freedom. […] Therefore, MRI-guided laser interstitial thermal therapy (laser ablation) is growing in popularity as a minimally invasive alternative to ATL. […] Importantly, laser ablation is an option for patients who prefer minimally invasive procedures, reducing barriers to patients undergoing surgery. […] This with a relatively favorable safety profile, so few permanent serious complications and most patients being discharged home post-operative day one. […] So laser ablation may be an option for these patients and reduce barriers to patients undergoing surgery. […] I would also add that one of the key findings that we found in addition is that patients who choose laser ablation first may still be candidates for open surgery if they fail.
#59 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Neurostimulation for the treatment of epilepsy includes vagus nerve stimulation (VNS) responsive neurostimulation (RNS), and deep brain stimulation (DBS). These are generally reserved for patients who are either not candidates for resective surgery or unwilling to undergo surgery. RNS can be used for patients with bitemporal seizure foci or foci involving eloquent brain regions. Neurostimulation also could be an option for patients who have seizure recurrence following surgery. In patients with bitemporal epilepsy, long-term ECoG data from the RNS system can provide information enabling identification if one temporal lobe responsible for the majority of the seizures in certain patients; if so, resective surgery may be a consideration in such patients. […] Apart from seizure management, patients with MTLE may have cognitive problems, psychiatric comorbidities, and psychosocial issues. A comprehensive approach to manage an individual with MTLE must take into account the cognitive and psychiatric comorbidities that often accompany this condition.
#60 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Neurostimulation for the treatment of epilepsy includes vagus nerve stimulation (VNS) responsive neurostimulation (RNS), and deep brain stimulation (DBS). These are generally reserved for patients who are either not candidates for resective surgery or unwilling to undergo surgery. RNS can be used for patients with bitemporal seizure foci or foci involving eloquent brain regions. Neurostimulation also could be an option for patients who have seizure recurrence following surgery. In patients with bitemporal epilepsy, long-term ECoG data from the RNS system can provide information enabling identification if one temporal lobe responsible for the majority of the seizures in certain patients; if so, resective surgery may be a consideration in such patients. […] Apart from seizure management, patients with MTLE may have cognitive problems, psychiatric comorbidities, and psychosocial issues. A comprehensive approach to manage an individual with MTLE must take into account the cognitive and psychiatric comorbidities that often accompany this condition.
#61 Seizure Treatment: Major Advances in Epilepsy Surgery Cure More People > News > Yale Medicine
https://www.yalemedicine.org/news/seizure-treatment-epilepsy-surgery-advances-cure-more-people
Laser ablation to destroy the abnormal tissue: Laser ablation, also known as thermal ablation, is less invasive than resection (although it still uses general anesthesia and a probe placed into the brain in the area to be ablated). […] A third option, called neurostimulation (or neuromodulation), involves implanting devices in the body to control the seizures. […] Neurostimulation is considered when surgery or laser ablation is too difficult or risky, often because a clear focal point of seizure origin does not exist or cant be identified. […] An implanted device works like a dimmer switch that lessens the intensity and frequency of seizures and sometimes stops them before they start, Dr. Quraishi explains. […] The rate of complete freedom from seizures is lower than with resection or laser ablation, and most patients also continue to take medication to treat the seizures.
#62 Temporal lobe seizure – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/temporal-lobe-seizure/diagnosis-treatment/drc-20378220
You also might not be able to have surgery if your healthcare team can’t find where the seizures start. Surgery also may not be an option if your seizures come from a part of the brain that affects speech, thinking, movement, memories and other important functions. […] A device placed under the skin of the chest stimulates the vagus nerve in the neck. This sends signals to the brain that lessen seizures. […] Surgeons place thin wires called electrodes in certain areas of the brain to produce electrical impulses. The impulses help the body manage the brain activity that causes seizures. The electrodes attach to a pacemakerlike device placed under the skin of the chest. The device manages how much stimulation happens.
#63 Temporal Lobe Epilepsy Treatment & Management: Approach Considerations, Antiepileptic Therapy, Neurostimulation: VNS, RNS, DBS
https://emedicine.medscape.com/article/1184509-treatment
There are many AEDs used for seizure control in temporal lobe epilepsy. […] Neurostimulation is a treatment option if the patient is refractory and is not a good surgical resective candidate. Vagus nerve stimulation (VNS) was approved by the US Food and Drug Administration (FDA) in 1997 for the treatment of intractable partial epilepsy in patients aged 4 years and older. […] Temporal lobectomy is the definitive treatment for medically intractable temporal lobe epilepsy, as it has a high seizure-free rate. […] Seizure-free state at 2 years postoperatively is predictive of long-term seizure-free outcome. In well-selected cases, 70-80% of patients with refractory temporal lobe epilepsy become seizure free after surgery. […] The dietary therapy that can be tried for intractable epilepsy is the ketogenic diet or the Modified Atkins diet.
#64 Temporal Lobe Epilepsy: Causes, Symptoms, and Treatment
https://www.healthline.com/health/temporal-lobe-epilepsy
Responsive neurostimulation: A stimulating device is implanted on the surface of the brain or in the brain tissue, attached to a battery-powered generator thats attached to the skull near the brain. The device detects seizures and sends an electrical stimulation to the area where the seizure is occurring in an attempt to stop it. […] Deep brain stimulation: This is an experimental treatment that involves implanting electrodes into a part of the brain called the thalamus. These electrodes emit electrical signals that stop seizures.
#65 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Neurostimulation for the treatment of epilepsy includes vagus nerve stimulation (VNS) responsive neurostimulation (RNS), and deep brain stimulation (DBS). These are generally reserved for patients who are either not candidates for resective surgery or unwilling to undergo surgery. RNS can be used for patients with bitemporal seizure foci or foci involving eloquent brain regions. Neurostimulation also could be an option for patients who have seizure recurrence following surgery. In patients with bitemporal epilepsy, long-term ECoG data from the RNS system can provide information enabling identification if one temporal lobe responsible for the majority of the seizures in certain patients; if so, resective surgery may be a consideration in such patients. […] Apart from seizure management, patients with MTLE may have cognitive problems, psychiatric comorbidities, and psychosocial issues. A comprehensive approach to manage an individual with MTLE must take into account the cognitive and psychiatric comorbidities that often accompany this condition.
#66 Temporal lobe seizure – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/temporal-lobe-seizure/diagnosis-treatment/drc-20378220
You also might not be able to have surgery if your healthcare team can’t find where the seizures start. Surgery also may not be an option if your seizures come from a part of the brain that affects speech, thinking, movement, memories and other important functions. […] A device placed under the skin of the chest stimulates the vagus nerve in the neck. This sends signals to the brain that lessen seizures. […] Surgeons place thin wires called electrodes in certain areas of the brain to produce electrical impulses. The impulses help the body manage the brain activity that causes seizures. The electrodes attach to a pacemakerlike device placed under the skin of the chest. The device manages how much stimulation happens.
#67 Temporal lobe seizure – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/temporal-lobe-seizure/diagnosis-treatment/drc-20378220
You also might not be able to have surgery if your healthcare team can’t find where the seizures start. Surgery also may not be an option if your seizures come from a part of the brain that affects speech, thinking, movement, memories and other important functions. […] A device placed under the skin of the chest stimulates the vagus nerve in the neck. This sends signals to the brain that lessen seizures. […] Surgeons place thin wires called electrodes in certain areas of the brain to produce electrical impulses. The impulses help the body manage the brain activity that causes seizures. The electrodes attach to a pacemakerlike device placed under the skin of the chest. The device manages how much stimulation happens.
#68 Neuromodulation for temporal lobe epilepsy: a scoping review | Acta Epileptologica | Full Text
https://aepi.biomedcentral.com/articles/10.1186/s42494-022-00086-0
In this review, we discuss the efficacy of these neuromodulatory approaches in the clinical management of refractory TLE. For each therapy, we provide the primary and secondary outcomes in clinical trials. […] DBS has also been applied to treat various forms of seizure disorders, from primarily motor seizures to absent seizures, and generalized and focal forms of epilepsy such as TLE. In epilepsy, a DBS system is integrated with sensing electrodes that detect seizures and deliver electric stimulation only when required, creating a closed-loop stimulation. […] The outcome and efficacy of DBS are complex, and they depend on both the intrinsic neuronal characteristics and stimulation parameters. […] The efficacy of DBS was found to vary with the location of seizure foci. In a longitudinal study where the anterior nucleus of the thalamus was stimulated among subjects with epilepsy, those with seizure focus in the temporal lobe showed greater median seizure reduction (44.2%) as compared to a 21.8% reduction in subjects receiving control treatment.
#69 Neuromodulation for temporal lobe epilepsy: a scoping review | Acta Epileptologica | Full Text
https://aepi.biomedcentral.com/articles/10.1186/s42494-022-00086-0
In most studies, hippocampal stimulation had encouraging results, with over 50% of the participants becoming seizure free. However, TLE patients with HS had less favorable results than those without HS. […] There are limited studies assessing the use of cerebellar DBS in the treatment of epilepsy, particularly TLE due to the small sample size. One study showed that stimulation of the cerebellar dentate nucleus attenuated ictal as well as interictal seizure activity. […] VNS can be applied on either the left or the right vagus nerve, although the right is not preferred as it is often associated with bradycardia and elevated blood glucose. The left cervical VNS is approved for the treatment of drug-resistant epilepsy and depression, while the right cervical VNS has been studied for the treatment of heart failure in clinical trials.
#70 Seizure Treatment: Major Advances in Epilepsy Surgery Cure More People > News > Yale Medicine
https://www.yalemedicine.org/news/seizure-treatment-epilepsy-surgery-advances-cure-more-people
Laser ablation to destroy the abnormal tissue: Laser ablation, also known as thermal ablation, is less invasive than resection (although it still uses general anesthesia and a probe placed into the brain in the area to be ablated). […] A third option, called neurostimulation (or neuromodulation), involves implanting devices in the body to control the seizures. […] Neurostimulation is considered when surgery or laser ablation is too difficult or risky, often because a clear focal point of seizure origin does not exist or cant be identified. […] An implanted device works like a dimmer switch that lessens the intensity and frequency of seizures and sometimes stops them before they start, Dr. Quraishi explains. […] The rate of complete freedom from seizures is lower than with resection or laser ablation, and most patients also continue to take medication to treat the seizures.
#71 Seizure Treatment: Major Advances in Epilepsy Surgery Cure More People > News > Yale Medicine
https://www.yalemedicine.org/news/seizure-treatment-epilepsy-surgery-advances-cure-more-people
Laser ablation to destroy the abnormal tissue: Laser ablation, also known as thermal ablation, is less invasive than resection (although it still uses general anesthesia and a probe placed into the brain in the area to be ablated). […] A third option, called neurostimulation (or neuromodulation), involves implanting devices in the body to control the seizures. […] Neurostimulation is considered when surgery or laser ablation is too difficult or risky, often because a clear focal point of seizure origin does not exist or cant be identified. […] An implanted device works like a dimmer switch that lessens the intensity and frequency of seizures and sometimes stops them before they start, Dr. Quraishi explains. […] The rate of complete freedom from seizures is lower than with resection or laser ablation, and most patients also continue to take medication to treat the seizures.
#72 Temporal Lobe Epilepsy Treatment & Management: Approach Considerations, Antiepileptic Therapy, Neurostimulation: VNS, RNS, DBS
https://emedicine.medscape.com/article/1184509-treatment
There are many AEDs used for seizure control in temporal lobe epilepsy. […] Neurostimulation is a treatment option if the patient is refractory and is not a good surgical resective candidate. Vagus nerve stimulation (VNS) was approved by the US Food and Drug Administration (FDA) in 1997 for the treatment of intractable partial epilepsy in patients aged 4 years and older. […] Temporal lobectomy is the definitive treatment for medically intractable temporal lobe epilepsy, as it has a high seizure-free rate. […] Seizure-free state at 2 years postoperatively is predictive of long-term seizure-free outcome. In well-selected cases, 70-80% of patients with refractory temporal lobe epilepsy become seizure free after surgery. […] The dietary therapy that can be tried for intractable epilepsy is the ketogenic diet or the Modified Atkins diet.
#73 Epilepsy: Treatment Options | AAFP
https://www.aafp.org/pubs/afp/issues/2017/0715/p87.html
The occurrence of a single seizure does not always require initiation of antiepileptic drugs. […] Treatment should begin with monotherapy. The appropriate choice of medication varies depending on seizure type. […] For patients with seizures that are not controlled with these agents, alternative treatments include surgical resection of the seizure focus, ketogenic diets, vagus nerve stimulators, and implantable brain neurostimulators. […] Early initiation of AED therapy may reduce the risk of sudden unexpected death in epilepsy (SUDEP), which is death in a person with epilepsy in whom no other cause of death is found. […] The ketogenic diet, a high-fat, low-carbohydrate, and low-protein diet, induces ketone body formation. Proponents claim a 10% seizure-free rate and seizure-reduction rates of up to 60%.
#74 Temporal lobe seizure – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/temporal-lobe-seizure/diagnosis-treatment/drc-20378220
Not everyone who has a seizure has another one. Your healthcare professional may decide not to start treatment until you’ve had more than one. […] Seizure treatment aims to find the best therapy to stop your seizures with the fewest side effects. […] Many medicines treat temporal lobe seizures. But many people can’t manage seizures fully with medicines alone. Side effects are common. They can include tiredness, weight gain and dizziness. […] Discuss possible side effects with your healthcare professional when thinking about treatments. Also ask what effect your seizure medicines may have on other medicines you take. For instance, some antiseizure medicines can affect how well birth control pills work. […] Following a ketogenic diet can improve seizure management. A ketogenic diet is high in fat and very low in carbohydrates. But it can be hard to follow because it allows only a very limited number of foods.
#75 Temporal lobe seizure – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/temporal-lobe-seizure/diagnosis-treatment/drc-20378220
Not everyone who has a seizure has another one. Your healthcare professional may decide not to start treatment until you’ve had more than one. […] Seizure treatment aims to find the best therapy to stop your seizures with the fewest side effects. […] Many medicines treat temporal lobe seizures. But many people can’t manage seizures fully with medicines alone. Side effects are common. They can include tiredness, weight gain and dizziness. […] Discuss possible side effects with your healthcare professional when thinking about treatments. Also ask what effect your seizure medicines may have on other medicines you take. For instance, some antiseizure medicines can affect how well birth control pills work. […] Following a ketogenic diet can improve seizure management. A ketogenic diet is high in fat and very low in carbohydrates. But it can be hard to follow because it allows only a very limited number of foods.
#76 Temporal Lobe Epilepsy Treatment & Management: Approach Considerations, Antiepileptic Therapy, Neurostimulation: VNS, RNS, DBS
https://emedicine.medscape.com/article/1184509-treatment
There are many AEDs used for seizure control in temporal lobe epilepsy. […] Neurostimulation is a treatment option if the patient is refractory and is not a good surgical resective candidate. Vagus nerve stimulation (VNS) was approved by the US Food and Drug Administration (FDA) in 1997 for the treatment of intractable partial epilepsy in patients aged 4 years and older. […] Temporal lobectomy is the definitive treatment for medically intractable temporal lobe epilepsy, as it has a high seizure-free rate. […] Seizure-free state at 2 years postoperatively is predictive of long-term seizure-free outcome. In well-selected cases, 70-80% of patients with refractory temporal lobe epilepsy become seizure free after surgery. […] The dietary therapy that can be tried for intractable epilepsy is the ketogenic diet or the Modified Atkins diet.
#77 Temporal lobe seizure – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube
https://www.augustahealth.com/disease/temporal-lobe-seizure/
Responsive neurostimulation. During responsive neurostimulation, a device implanted on the surface of your brain or within brain tissue can detect seizure activity and deliver an electrical stimulation to the detected area to stop the seizure. […] Dietary therapy. Following a diet that’s high in fat and low in carbohydrates, known as a ketogenic diet, can improve seizure control. Variations on a high-fat, low-carbohydrate diet, such as the low glycemic index and modified Atkins diets, may be less effective. However, they aren’t as restrictive as the ketogenic diet and might provide some benefit.
#78 Epilepsy: Treatment Options | AAFP
https://www.aafp.org/pubs/afp/issues/2017/0715/p87.html
The occurrence of a single seizure does not always require initiation of antiepileptic drugs. […] Treatment should begin with monotherapy. The appropriate choice of medication varies depending on seizure type. […] For patients with seizures that are not controlled with these agents, alternative treatments include surgical resection of the seizure focus, ketogenic diets, vagus nerve stimulators, and implantable brain neurostimulators. […] Early initiation of AED therapy may reduce the risk of sudden unexpected death in epilepsy (SUDEP), which is death in a person with epilepsy in whom no other cause of death is found. […] The ketogenic diet, a high-fat, low-carbohydrate, and low-protein diet, induces ketone body formation. Proponents claim a 10% seizure-free rate and seizure-reduction rates of up to 60%.
#79 Temporal lobe seizure – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube
https://www.augustahealth.com/disease/temporal-lobe-seizure/
Responsive neurostimulation. During responsive neurostimulation, a device implanted on the surface of your brain or within brain tissue can detect seizure activity and deliver an electrical stimulation to the detected area to stop the seizure. […] Dietary therapy. Following a diet that’s high in fat and low in carbohydrates, known as a ketogenic diet, can improve seizure control. Variations on a high-fat, low-carbohydrate diet, such as the low glycemic index and modified Atkins diets, may be less effective. However, they aren’t as restrictive as the ketogenic diet and might provide some benefit.
#80 Azthena logo with the word Azthena
https://www.news-medical.net/news/20191030/Researchers-develop-new-therapeutic-concept-for-treatment-of-temporal-lobe-epilepsy.aspx
Teams of researchers from Charit – UniversitÃ¤tsmedizin Berlin and the Medical University of Innsbruck have developed a new therapeutic concept for the treatment of temporal lobe epilepsy. […] The new treatment method is based on targeted gene therapy. This technique involves the selective delivery of a specific gene to nerve cells within the area of the brain from which the epileptic seizures originate. […] High-frequency stimulation of the nerve cells, such as that seen at the beginning of a seizure, results in the release of stored dynorphins. […] Using an animal model, the researchers were able to show that this gene therapy is capable of suppressing epileptic seizures for several months. […] „The results from our study are encouraging, prompting us to hope that this new therapeutic concept could also be successful in humans,” says Prof. Heilbronn. […] Prof. Heilbronn and Prof. Schwarz hope to make this new gene therapy available for clinical use as rapidly as possible. […] If the treatment is shown to be effective, this one-off treatment would offer a real alternative to patients on whom TLE drugs fail.
#81 Azthena logo with the word Azthena
https://www.news-medical.net/news/20191030/Researchers-develop-new-therapeutic-concept-for-treatment-of-temporal-lobe-epilepsy.aspx
Teams of researchers from Charit – UniversitÃ¤tsmedizin Berlin and the Medical University of Innsbruck have developed a new therapeutic concept for the treatment of temporal lobe epilepsy. […] The new treatment method is based on targeted gene therapy. This technique involves the selective delivery of a specific gene to nerve cells within the area of the brain from which the epileptic seizures originate. […] High-frequency stimulation of the nerve cells, such as that seen at the beginning of a seizure, results in the release of stored dynorphins. […] Using an animal model, the researchers were able to show that this gene therapy is capable of suppressing epileptic seizures for several months. […] „The results from our study are encouraging, prompting us to hope that this new therapeutic concept could also be successful in humans,” says Prof. Heilbronn. […] Prof. Heilbronn and Prof. Schwarz hope to make this new gene therapy available for clinical use as rapidly as possible. […] If the treatment is shown to be effective, this one-off treatment would offer a real alternative to patients on whom TLE drugs fail.
#82 Azthena logo with the word Azthena
https://www.news-medical.net/news/20191030/Researchers-develop-new-therapeutic-concept-for-treatment-of-temporal-lobe-epilepsy.aspx
Teams of researchers from Charit – UniversitÃ¤tsmedizin Berlin and the Medical University of Innsbruck have developed a new therapeutic concept for the treatment of temporal lobe epilepsy. […] The new treatment method is based on targeted gene therapy. This technique involves the selective delivery of a specific gene to nerve cells within the area of the brain from which the epileptic seizures originate. […] High-frequency stimulation of the nerve cells, such as that seen at the beginning of a seizure, results in the release of stored dynorphins. […] Using an animal model, the researchers were able to show that this gene therapy is capable of suppressing epileptic seizures for several months. […] „The results from our study are encouraging, prompting us to hope that this new therapeutic concept could also be successful in humans,” says Prof. Heilbronn. […] Prof. Heilbronn and Prof. Schwarz hope to make this new gene therapy available for clinical use as rapidly as possible. […] If the treatment is shown to be effective, this one-off treatment would offer a real alternative to patients on whom TLE drugs fail.
#83 Azthena logo with the word Azthena
https://www.news-medical.net/news/20191030/Researchers-develop-new-therapeutic-concept-for-treatment-of-temporal-lobe-epilepsy.aspx
Teams of researchers from Charit – UniversitÃ¤tsmedizin Berlin and the Medical University of Innsbruck have developed a new therapeutic concept for the treatment of temporal lobe epilepsy. […] The new treatment method is based on targeted gene therapy. This technique involves the selective delivery of a specific gene to nerve cells within the area of the brain from which the epileptic seizures originate. […] High-frequency stimulation of the nerve cells, such as that seen at the beginning of a seizure, results in the release of stored dynorphins. […] Using an animal model, the researchers were able to show that this gene therapy is capable of suppressing epileptic seizures for several months. […] „The results from our study are encouraging, prompting us to hope that this new therapeutic concept could also be successful in humans,” says Prof. Heilbronn. […] Prof. Heilbronn and Prof. Schwarz hope to make this new gene therapy available for clinical use as rapidly as possible. […] If the treatment is shown to be effective, this one-off treatment would offer a real alternative to patients on whom TLE drugs fail.
#84 Temporal Lobe Epilepsy (TLE) | Programs & Pipeline | uniQure
https://www.uniqure.com/programs-pipeline/temporal-lobe-epilepsy-tle
The clinical trial of uniQures gene therapy candidate for the treatment of mesial temporal lobe epilepsy (MTLE) initiated in 2024. […] The therapeutic goal is to lower the expression of GluK2 containing kainate receptors, which are believed to trigger epilepsy when aberrantly expressed in the epileptic hippocampus. AMT-260 represents a novel potential one-time administered approach to treating refractory MTLE. […] There are few treatment options for patients who have refractory MTLE, and we are pleased to have begun the clinical investigation of this one-time administered gene therapy approach as a potential new treatment.
#85 Temporal Lobe Epilepsy (TLE) | Programs & Pipeline | uniQure
https://www.uniqure.com/programs-pipeline/temporal-lobe-epilepsy-tle
The clinical trial of uniQures gene therapy candidate for the treatment of mesial temporal lobe epilepsy (MTLE) initiated in 2024. […] The therapeutic goal is to lower the expression of GluK2 containing kainate receptors, which are believed to trigger epilepsy when aberrantly expressed in the epileptic hippocampus. AMT-260 represents a novel potential one-time administered approach to treating refractory MTLE. […] There are few treatment options for patients who have refractory MTLE, and we are pleased to have begun the clinical investigation of this one-time administered gene therapy approach as a potential new treatment.
#86 New UC San Diego Health among First in Nation to Perform Regenerative Brain Cell Procedure for Epilepsy
https://health.ucsd.edu/news/press-releases/2023-07-26-new-uc-san-diego-health-among-first-in-nation-to-perform-regenerative-brain-cell-procedure-for-epilepsy/
Sharona Ben-Haim, MD, performed the third ever experimental regenerative brain cell therapy for epilepsy earlier this month. The new procedure is part of a national clinical trial aimed at eliminating seizures, which could revolutionize the treatment of temporal lobe epilepsy. […] In what could lead to a revolutionary advancement in the treatment of temporal lobe epilepsy, UC San Diego Health has become one of the first health systems in the country to inject regenerative cells into the brain to treat epileptic seizures. […] If successful, the first-ever regenerative human cell experimental therapy, NRTX-1001, could provide drug-resistant temporal lobe epilepsy patients with the first non-destructive option to potentially cure their seizures. […] This experimental cell therapy implants healthy human brain cells into the damaged temporal lobe with the hope that those new cells will begin establishing connections in the patients brain, to ultimately make a healthier temporal lobe.
#87 New UC San Diego Health among First in Nation to Perform Regenerative Brain Cell Procedure for Epilepsy
https://health.ucsd.edu/news/press-releases/2023-07-26-new-uc-san-diego-health-among-first-in-nation-to-perform-regenerative-brain-cell-procedure-for-epilepsy/
Sharona Ben-Haim, MD, performed the third ever experimental regenerative brain cell therapy for epilepsy earlier this month. The new procedure is part of a national clinical trial aimed at eliminating seizures, which could revolutionize the treatment of temporal lobe epilepsy. […] In what could lead to a revolutionary advancement in the treatment of temporal lobe epilepsy, UC San Diego Health has become one of the first health systems in the country to inject regenerative cells into the brain to treat epileptic seizures. […] If successful, the first-ever regenerative human cell experimental therapy, NRTX-1001, could provide drug-resistant temporal lobe epilepsy patients with the first non-destructive option to potentially cure their seizures. […] This experimental cell therapy implants healthy human brain cells into the damaged temporal lobe with the hope that those new cells will begin establishing connections in the patients brain, to ultimately make a healthier temporal lobe.
#88 New UC San Diego Health among First in Nation to Perform Regenerative Brain Cell Procedure for Epilepsy
https://health.ucsd.edu/news/press-releases/2023-07-26-new-uc-san-diego-health-among-first-in-nation-to-perform-regenerative-brain-cell-procedure-for-epilepsy/
Sharona Ben-Haim, MD, performed the third ever experimental regenerative brain cell therapy for epilepsy earlier this month. The new procedure is part of a national clinical trial aimed at eliminating seizures, which could revolutionize the treatment of temporal lobe epilepsy. […] In what could lead to a revolutionary advancement in the treatment of temporal lobe epilepsy, UC San Diego Health has become one of the first health systems in the country to inject regenerative cells into the brain to treat epileptic seizures. […] If successful, the first-ever regenerative human cell experimental therapy, NRTX-1001, could provide drug-resistant temporal lobe epilepsy patients with the first non-destructive option to potentially cure their seizures. […] This experimental cell therapy implants healthy human brain cells into the damaged temporal lobe with the hope that those new cells will begin establishing connections in the patients brain, to ultimately make a healthier temporal lobe.
#89 New UC San Diego Health among First in Nation to Perform Regenerative Brain Cell Procedure for Epilepsy
https://health.ucsd.edu/news/press-releases/2023-07-26-new-uc-san-diego-health-among-first-in-nation-to-perform-regenerative-brain-cell-procedure-for-epilepsy/
This new experimental regenerative therapy could potentially treat multiple parts of the brain without tissue removal, offering new hope to drug-resistant epilepsy patients. […] Our hope is that this procedure has such a high success rate and good tolerability that it becomes the standard of care for all drug-resistant focal epilepsies. […] Patients who participate in the trial will be monitored regularly for two years after the procedure to study the effects of the implanted interneurons. Preliminary data reported in June demonstrates a more than 90% reduction in seizure frequency in the first and second patients at one year and seven months, respectively, post-treatment.
#90 Neurona Therapeutics Presents One-Year Data on the First Patient Treated with NRTX-1001 Cell Therapy in an Ongoing Phase I/II Trial for Drug-resistant Focal Epilepsy
https://www.neuronatherapeutics.com/news/press-releases/061523/
it is gratifying to witness the first two patients achieving seizure-relief without additional cognitive impairment to date, which supports the therapeutic potential of NRTX-1001. […] Both patients continue to report reduced overall seizure counts of 90% at one year- and seven-months post NRTX-1001 administration, respectively. […] The clinical study is designed to evaluate the safety and efficacy of a single administration of NRTX-1001 for drug-resistant MTLE. […] NRTX-1001 is a regenerative neural cell therapy candidate derived from human pluripotent stem cells. […] NRTX-1001 is intended to integrate and innervate on-target, and designed to durably silence seizure activity in the epileptic region of the brain. […] For people with seizures resistant to anti-seizure drugs, epilepsy surgery – where the damaged temporal lobe is surgically removed or ablated by laser – can be an option. However, the current surgical options are not available or effective for all patients, are tissue-destructive, and can have significant adverse effects.
#91 Neurona Therapeutics Presents One-Year Data on the First Patient Treated with NRTX-1001 Cell Therapy in an Ongoing Phase I/II Trial for Drug-resistant Focal Epilepsy
https://www.neuronatherapeutics.com/news/press-releases/061523/
it is gratifying to witness the first two patients achieving seizure-relief without additional cognitive impairment to date, which supports the therapeutic potential of NRTX-1001. […] Both patients continue to report reduced overall seizure counts of 90% at one year- and seven-months post NRTX-1001 administration, respectively. […] The clinical study is designed to evaluate the safety and efficacy of a single administration of NRTX-1001 for drug-resistant MTLE. […] NRTX-1001 is a regenerative neural cell therapy candidate derived from human pluripotent stem cells. […] NRTX-1001 is intended to integrate and innervate on-target, and designed to durably silence seizure activity in the epileptic region of the brain. […] For people with seizures resistant to anti-seizure drugs, epilepsy surgery – where the damaged temporal lobe is surgically removed or ablated by laser – can be an option. However, the current surgical options are not available or effective for all patients, are tissue-destructive, and can have significant adverse effects.
#92 Neurona Therapeutics Presents One-Year Data on the First Patient Treated with NRTX-1001 Cell Therapy in an Ongoing Phase I/II Trial for Drug-resistant Focal Epilepsy
https://www.neuronatherapeutics.com/news/press-releases/061523/
Promising reduction (95%) in seizure frequency at the key one-year post treatment endpoint in the first patient to receive NRTX-1001, memory improvements, and seizure-freedom since seven-months post-treatment […] The preliminary data demonstrate promising reduction (90%) in seizure frequency in the first and second patients at one year and seven-months post-treatment, respectively. In addition, neuropsychological testing suggests an improvement in memory after NRTX-1001 administration. […] Patient-one has reached the one-year post treatment endpoint and has achieved a 95% overall monthly seizure reduction, including elimination of all seizure events since the seventh month post-administration of NRTX-1001 […] They were candidates for lobectomy or ablation surgery to remove the epileptic seizure-generating temporal lobe, albeit with an associated risk of causing further, irreversible cognitive deficits. Instead, they courageously chose to be first to receive NRTX-1001 cell therapy.
#93 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Neurostimulation for the treatment of epilepsy includes vagus nerve stimulation (VNS) responsive neurostimulation (RNS), and deep brain stimulation (DBS). These are generally reserved for patients who are either not candidates for resective surgery or unwilling to undergo surgery. RNS can be used for patients with bitemporal seizure foci or foci involving eloquent brain regions. Neurostimulation also could be an option for patients who have seizure recurrence following surgery. In patients with bitemporal epilepsy, long-term ECoG data from the RNS system can provide information enabling identification if one temporal lobe responsible for the majority of the seizures in certain patients; if so, resective surgery may be a consideration in such patients. […] Apart from seizure management, patients with MTLE may have cognitive problems, psychiatric comorbidities, and psychosocial issues. A comprehensive approach to manage an individual with MTLE must take into account the cognitive and psychiatric comorbidities that often accompany this condition.
#94 Mesial Temporal Lobe Epilepsy – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK554432/
Neurostimulation for the treatment of epilepsy includes vagus nerve stimulation (VNS) responsive neurostimulation (RNS), and deep brain stimulation (DBS). These are generally reserved for patients who are either not candidates for resective surgery or unwilling to undergo surgery. RNS can be used for patients with bitemporal seizure foci or foci involving eloquent brain regions. Neurostimulation also could be an option for patients who have seizure recurrence following surgery. In patients with bitemporal epilepsy, long-term ECoG data from the RNS system can provide information enabling identification if one temporal lobe responsible for the majority of the seizures in certain patients; if so, resective surgery may be a consideration in such patients. […] Apart from seizure management, patients with MTLE may have cognitive problems, psychiatric comorbidities, and psychosocial issues. A comprehensive approach to manage an individual with MTLE must take into account the cognitive and psychiatric comorbidities that often accompany this condition.
#95 Epilepsy in Adults (Causes, Symptoms, and Treatment)
https://patient.info/doctor/epilepsy-in-adults
All adults with epilepsy should have a comprehensive care plan, which should include lifestyle issues as well as medical issues. […] Epilepsy specialist nurses (ESNs) should be an integral part of the network of care. […] A Cochrane review found that two types of intervention (specialist epilepsy nurse and self management education) showed some evidence of benefit; there was no clear evidence that other service models substantially improved outcomes for adults with epilepsy. […] The decision whether or not to start AED treatment must be based on the relative risks of recurrent seizures and the commitment to long-term medication with potential adverse effects. AEDs should not be given until the diagnosis of epilepsy has been confirmed. […] The AED treatment strategy should be individualised according to the seizure type, epilepsy syndrome, co-medication and comorbidity, lifestyle and the preferences of the person and their family and/or carers as appropriate.
#96 Epilepsy in Adults (Causes, Symptoms, and Treatment)
https://patient.info/doctor/epilepsy-in-adults
All adults with epilepsy should have a comprehensive care plan, which should include lifestyle issues as well as medical issues. […] Epilepsy specialist nurses (ESNs) should be an integral part of the network of care. […] A Cochrane review found that two types of intervention (specialist epilepsy nurse and self management education) showed some evidence of benefit; there was no clear evidence that other service models substantially improved outcomes for adults with epilepsy. […] The decision whether or not to start AED treatment must be based on the relative risks of recurrent seizures and the commitment to long-term medication with potential adverse effects. AEDs should not be given until the diagnosis of epilepsy has been confirmed. […] The AED treatment strategy should be individualised according to the seizure type, epilepsy syndrome, co-medication and comorbidity, lifestyle and the preferences of the person and their family and/or carers as appropriate.
#97 Epilepsy
https://www.nhs.uk/conditions/epilepsy/
If you have epilepsy you’ll be supported by your GP and a team of specialists. You’ll have check-ups at least once a year. […] Your team will work with you to agree a care plan that includes details of the care and support you need. The care plan will tell your family or carers what to do when you have a seizure. […] The main treatment for epilepsy is medicine to prevent seizures, called anti-epileptic or anti-seizure medicine. […] You may also be given medicine to use as emergency treatment if you have a seizure that lasts longer than usual. A family member or carer will need to give this to you. […] There are different anti-epileptic medicines. The medicine recommended for you depends on the type of seizures and things like your age, sex and any other conditions you have. […] You may need to try different medicines to find what works for you.
#98 Epilepsy
https://www.nhs.uk/conditions/epilepsy/
If you have epilepsy you’ll be supported by your GP and a team of specialists. You’ll have check-ups at least once a year. […] Your team will work with you to agree a care plan that includes details of the care and support you need. The care plan will tell your family or carers what to do when you have a seizure. […] The main treatment for epilepsy is medicine to prevent seizures, called anti-epileptic or anti-seizure medicine. […] You may also be given medicine to use as emergency treatment if you have a seizure that lasts longer than usual. A family member or carer will need to give this to you. […] There are different anti-epileptic medicines. The medicine recommended for you depends on the type of seizures and things like your age, sex and any other conditions you have. […] You may need to try different medicines to find what works for you.
#99 Epilepsy
https://www.nhs.uk/conditions/epilepsy/
If you have epilepsy you’ll be supported by your GP and a team of specialists. You’ll have check-ups at least once a year. […] Your team will work with you to agree a care plan that includes details of the care and support you need. The care plan will tell your family or carers what to do when you have a seizure. […] The main treatment for epilepsy is medicine to prevent seizures, called anti-epileptic or anti-seizure medicine. […] You may also be given medicine to use as emergency treatment if you have a seizure that lasts longer than usual. A family member or carer will need to give this to you. […] There are different anti-epileptic medicines. The medicine recommended for you depends on the type of seizures and things like your age, sex and any other conditions you have. […] You may need to try different medicines to find what works for you.
#100
https://aesnet.org/abstractslisting/results-of-a-drug-withdrawal-protocol-after-temporal-lobe-epilepsy-surgery
It is established that temporal lobe epilepsy surgery is effective to reduce or eliminate seizures in almost two thirds of drug resistant patients. […] A protocol of drug withdrawal was applied in patients after two years of follow up and data are presented and discussed. […] Patients with clinically intractable temporal lobe epilepsy (TLE) submitted to surgical treatment who became seizure free for a period of two years and had serial EEG exams without epileptic discharges were candidates to be submitted to the protocol of AED withdrawal. […] The withdrawal was performed gradually and the drug was reduced 25% of the total dose in a period of five half-lives of the drug. […] In the last follow up, 37 (57,81%) were seizure free without AED; 4 (6,25%) the withdrawal was interrupted because epileptic discharges appeared in EEG and in 23 (35,94%) seizures occurred.
#101
https://aesnet.org/abstractslisting/results-of-a-drug-withdrawal-protocol-after-temporal-lobe-epilepsy-surgery
It is established that temporal lobe epilepsy surgery is effective to reduce or eliminate seizures in almost two thirds of drug resistant patients. […] A protocol of drug withdrawal was applied in patients after two years of follow up and data are presented and discussed. […] Patients with clinically intractable temporal lobe epilepsy (TLE) submitted to surgical treatment who became seizure free for a period of two years and had serial EEG exams without epileptic discharges were candidates to be submitted to the protocol of AED withdrawal. […] The withdrawal was performed gradually and the drug was reduced 25% of the total dose in a period of five half-lives of the drug. […] In the last follow up, 37 (57,81%) were seizure free without AED; 4 (6,25%) the withdrawal was interrupted because epileptic discharges appeared in EEG and in 23 (35,94%) seizures occurred.
#102
https://aesnet.org/abstractslisting/results-of-a-drug-withdrawal-protocol-after-temporal-lobe-epilepsy-surgery
It is established that temporal lobe epilepsy surgery is effective to reduce or eliminate seizures in almost two thirds of drug resistant patients. […] A protocol of drug withdrawal was applied in patients after two years of follow up and data are presented and discussed. […] Patients with clinically intractable temporal lobe epilepsy (TLE) submitted to surgical treatment who became seizure free for a period of two years and had serial EEG exams without epileptic discharges were candidates to be submitted to the protocol of AED withdrawal. […] The withdrawal was performed gradually and the drug was reduced 25% of the total dose in a period of five half-lives of the drug. […] In the last follow up, 37 (57,81%) were seizure free without AED; 4 (6,25%) the withdrawal was interrupted because epileptic discharges appeared in EEG and in 23 (35,94%) seizures occurred.
#103
https://aesnet.org/abstractslisting/results-of-a-drug-withdrawal-protocol-after-temporal-lobe-epilepsy-surgery
It is established that temporal lobe epilepsy surgery is effective to reduce or eliminate seizures in almost two thirds of drug resistant patients. […] A protocol of drug withdrawal was applied in patients after two years of follow up and data are presented and discussed. […] Patients with clinically intractable temporal lobe epilepsy (TLE) submitted to surgical treatment who became seizure free for a period of two years and had serial EEG exams without epileptic discharges were candidates to be submitted to the protocol of AED withdrawal. […] The withdrawal was performed gradually and the drug was reduced 25% of the total dose in a period of five half-lives of the drug. […] In the last follow up, 37 (57,81%) were seizure free without AED; 4 (6,25%) the withdrawal was interrupted because epileptic discharges appeared in EEG and in 23 (35,94%) seizures occurred.
#104
https://aesnet.org/abstractslisting/results-of-a-drug-withdrawal-protocol-after-temporal-lobe-epilepsy-surgery
Our results to withdraw medication after temporal lobe resections are similar to other series. Our protocol seems to be safe, with high index of seizures recurrence, but when the anti epileptic drugs were fully took back, the great majority of them became seizure free again. The efficacy was significant, with almost two thirds of patients submitted to our protocol of anti epileptic drugs withdrawal, fully or partially reduced medication.
#105 Factors influencing the long-term prognosis of patients with temporal lobe epilepsy: a single center study – Yang – Annals of Palliative Medicine
https://apm.amegroups.org/article/view/51598/html
Background: This study aimed to explore the risk factors influencing the long-term prognosis of temporal lobe epilepsy (TLE) patients treated with drug therapy or surgical treatment. […] Patients who met the criteria of drug-resistant TLE were evaluated for treatment with temporal lobectomy. […] Overall, 23.2% TLE patients (26/112) achieved seizure freedom after treatment with AEDs alone, while the remaining 76.8% (86/112) of patients were diagnosed as drug-resistant epilepsy (DRE). Of the 45 DRE patients who subsequently received surgical treatment, 77.8% (35/45) achieved seizure freedom, with successful AED withdrawal in 11 patients. […] Effective early monotherapy was an independent predictor for good therapeutic effect in all TLE patients (OR: 0.16; 95% CI: 0.040.66; P=0.007). […] Multivariate logistic regression analysis showed the predictors of good prognosis in DRE patients after surgery to be unilateral origin of discharges in electroencephalogram (EEG, OR =0.20, 95% CI: 0.060.74, P=0.016), no secondary generalized tonic-clonic seizures (GTCS, OR =0.08, 95% CI: 0.010.67, P=0.002), and not needing a subdural electrode (OR =15.4, 95% CI: 1.36174.38, P=0.027).
#106 Factors influencing the long-term prognosis of patients with temporal lobe epilepsy: a single center study – Yang – Annals of Palliative Medicine
https://apm.amegroups.org/article/view/51598/html
Background: This study aimed to explore the risk factors influencing the long-term prognosis of temporal lobe epilepsy (TLE) patients treated with drug therapy or surgical treatment. […] Patients who met the criteria of drug-resistant TLE were evaluated for treatment with temporal lobectomy. […] Overall, 23.2% TLE patients (26/112) achieved seizure freedom after treatment with AEDs alone, while the remaining 76.8% (86/112) of patients were diagnosed as drug-resistant epilepsy (DRE). Of the 45 DRE patients who subsequently received surgical treatment, 77.8% (35/45) achieved seizure freedom, with successful AED withdrawal in 11 patients. […] Effective early monotherapy was an independent predictor for good therapeutic effect in all TLE patients (OR: 0.16; 95% CI: 0.040.66; P=0.007). […] Multivariate logistic regression analysis showed the predictors of good prognosis in DRE patients after surgery to be unilateral origin of discharges in electroencephalogram (EEG, OR =0.20, 95% CI: 0.060.74, P=0.016), no secondary generalized tonic-clonic seizures (GTCS, OR =0.08, 95% CI: 0.010.67, P=0.002), and not needing a subdural electrode (OR =15.4, 95% CI: 1.36174.38, P=0.027).
#107 Factors influencing the long-term prognosis of patients with temporal lobe epilepsy: a single center study – Yang – Annals of Palliative Medicine
https://apm.amegroups.org/article/view/51598/html
Background: This study aimed to explore the risk factors influencing the long-term prognosis of temporal lobe epilepsy (TLE) patients treated with drug therapy or surgical treatment. […] Patients who met the criteria of drug-resistant TLE were evaluated for treatment with temporal lobectomy. […] Overall, 23.2% TLE patients (26/112) achieved seizure freedom after treatment with AEDs alone, while the remaining 76.8% (86/112) of patients were diagnosed as drug-resistant epilepsy (DRE). Of the 45 DRE patients who subsequently received surgical treatment, 77.8% (35/45) achieved seizure freedom, with successful AED withdrawal in 11 patients. […] Effective early monotherapy was an independent predictor for good therapeutic effect in all TLE patients (OR: 0.16; 95% CI: 0.040.66; P=0.007). […] Multivariate logistic regression analysis showed the predictors of good prognosis in DRE patients after surgery to be unilateral origin of discharges in electroencephalogram (EEG, OR =0.20, 95% CI: 0.060.74, P=0.016), no secondary generalized tonic-clonic seizures (GTCS, OR =0.08, 95% CI: 0.010.67, P=0.002), and not needing a subdural electrode (OR =15.4, 95% CI: 1.36174.38, P=0.027).
#108 Factors influencing the long-term prognosis of patients with temporal lobe epilepsy: a single center study – Yang – Annals of Palliative Medicine
https://apm.amegroups.org/article/view/51598/html
Background: This study aimed to explore the risk factors influencing the long-term prognosis of temporal lobe epilepsy (TLE) patients treated with drug therapy or surgical treatment. […] Patients who met the criteria of drug-resistant TLE were evaluated for treatment with temporal lobectomy. […] Overall, 23.2% TLE patients (26/112) achieved seizure freedom after treatment with AEDs alone, while the remaining 76.8% (86/112) of patients were diagnosed as drug-resistant epilepsy (DRE). Of the 45 DRE patients who subsequently received surgical treatment, 77.8% (35/45) achieved seizure freedom, with successful AED withdrawal in 11 patients. […] Effective early monotherapy was an independent predictor for good therapeutic effect in all TLE patients (OR: 0.16; 95% CI: 0.040.66; P=0.007). […] Multivariate logistic regression analysis showed the predictors of good prognosis in DRE patients after surgery to be unilateral origin of discharges in electroencephalogram (EEG, OR =0.20, 95% CI: 0.060.74, P=0.016), no secondary generalized tonic-clonic seizures (GTCS, OR =0.08, 95% CI: 0.010.67, P=0.002), and not needing a subdural electrode (OR =15.4, 95% CI: 1.36174.38, P=0.027).
#109 Factors influencing the long-term prognosis of patients with temporal lobe epilepsy: a single center study – Yang – Annals of Palliative Medicine
https://apm.amegroups.org/article/view/51598/html
Background: This study aimed to explore the risk factors influencing the long-term prognosis of temporal lobe epilepsy (TLE) patients treated with drug therapy or surgical treatment. […] Patients who met the criteria of drug-resistant TLE were evaluated for treatment with temporal lobectomy. […] Overall, 23.2% TLE patients (26/112) achieved seizure freedom after treatment with AEDs alone, while the remaining 76.8% (86/112) of patients were diagnosed as drug-resistant epilepsy (DRE). Of the 45 DRE patients who subsequently received surgical treatment, 77.8% (35/45) achieved seizure freedom, with successful AED withdrawal in 11 patients. […] Effective early monotherapy was an independent predictor for good therapeutic effect in all TLE patients (OR: 0.16; 95% CI: 0.040.66; P=0.007). […] Multivariate logistic regression analysis showed the predictors of good prognosis in DRE patients after surgery to be unilateral origin of discharges in electroencephalogram (EEG, OR =0.20, 95% CI: 0.060.74, P=0.016), no secondary generalized tonic-clonic seizures (GTCS, OR =0.08, 95% CI: 0.010.67, P=0.002), and not needing a subdural electrode (OR =15.4, 95% CI: 1.36174.38, P=0.027).
#110 Temporal lobe epilepsy | Tidsskrift for Den norske legeforening
https://tidsskriftet.no/en/2023/01/clinical-review/temporal-lobe-epilepsy
Two randomised trials and numerous observational studies have shown that in difficult-to-treat temporal lobe epilepsy, surgery is significantly more effective than continued medical treatment. […] The results of surgery are particularly good if the patient has hippocampal sclerosis. […] However, it is important that these patients are referred for surgical assessment early in the disease course, as a long disease duration reduces the likelihood of a good outcome. […] In Norway, epilepsy surgery has been centralised to Rikshospitalet and the National Centre for Epilepsy, both in Oslo. Here, potential candidates for surgery undergo comprehensive pre-operative testing with the aim of localising the epileptogenic network as precisely as possible. Interventions are personalised for each patient based on these findings.
#111 Temporal lobe epilepsy | Tidsskrift for Den norske legeforening
https://tidsskriftet.no/en/2023/01/clinical-review/temporal-lobe-epilepsy
Two randomised trials and numerous observational studies have shown that in difficult-to-treat temporal lobe epilepsy, surgery is significantly more effective than continued medical treatment. […] The results of surgery are particularly good if the patient has hippocampal sclerosis. […] However, it is important that these patients are referred for surgical assessment early in the disease course, as a long disease duration reduces the likelihood of a good outcome. […] In Norway, epilepsy surgery has been centralised to Rikshospitalet and the National Centre for Epilepsy, both in Oslo. Here, potential candidates for surgery undergo comprehensive pre-operative testing with the aim of localising the epileptogenic network as precisely as possible. Interventions are personalised for each patient based on these findings.
#112 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy
https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/
The average 20-year delay of referral to epilepsy centers can be improved. […] Approximately, one-third of people with epilepsy are estimated to have drug-resistant epilepsy (DRE). […] Despite the high global burden of epilepsy, there is often a delay in initial diagnosis, even in developed countries. […] Notably, on average there is a delay of more than 20 years between initial diagnosis and surgical management of people who are failed by optimal use of ASMs. […] After treatment with ASMs, TS had a reduction in her seizure burden, but did not achieve seizure freedom. […] JF’s evaluation at our level 4 epilepsy center with videoEEG revealed seizures arising from his left temporal lobe. […] Having been failed by 2 ASMs, JF’s seizures were identified as DRE, and further presurgical workup was initiated.
#113 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy
https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/
The average 20-year delay of referral to epilepsy centers can be improved. […] Approximately, one-third of people with epilepsy are estimated to have drug-resistant epilepsy (DRE). […] Despite the high global burden of epilepsy, there is often a delay in initial diagnosis, even in developed countries. […] Notably, on average there is a delay of more than 20 years between initial diagnosis and surgical management of people who are failed by optimal use of ASMs. […] After treatment with ASMs, TS had a reduction in her seizure burden, but did not achieve seizure freedom. […] JF’s evaluation at our level 4 epilepsy center with videoEEG revealed seizures arising from his left temporal lobe. […] Having been failed by 2 ASMs, JF’s seizures were identified as DRE, and further presurgical workup was initiated.
#114 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy
https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/
The ideal treatment goal for epilepsy includes complete seizure freedom and the absence of any side effects. […] Appropriate and targeted treatment (eg, surgical resection, neuromodulation, a combination of both, and continued ASM therapy) requires a multidisciplinary approach. […] Prompt referral to comprehensive epilepsy centers allows such detailed evaluation and consideration of a multiplicity of alternative treatment plans.
#115 Diagnostic & Treatment Delay in Temporal Lobe Epilepsy
https://practicalneurology.com/diseases-diagnoses/epilepsy-seizures/diagnostic-treatment-delay-in-temporal-lobe-epilepsy/31835/
The ideal treatment goal for epilepsy includes complete seizure freedom and the absence of any side effects. […] Appropriate and targeted treatment (eg, surgical resection, neuromodulation, a combination of both, and continued ASM therapy) requires a multidisciplinary approach. […] Prompt referral to comprehensive epilepsy centers allows such detailed evaluation and consideration of a multiplicity of alternative treatment plans.