Complete Seizure Cessation In Severe Drug Resistant Extratemporal Seizures Associated With Dnet: A Gamma Knife Radiosurgery Case ReportAmir Samadi1, Adyl Melhaoui1, Jean Isnard2, Hervé Isnard2, Patrick Chauvel3, Jean Regis41Dep of Stereotactic and Functional Neurosurgery 2 Dep of Functional Neurology and Epileptology 3 Dep of Clinical Neurophysiology 4 Keywords: epilepsy, gamma knife, seizures, brain tumor, outcome
Several recent studies have demonstrated the safety and efficacy of Gamma Knife radiosurgery (GKR) in hypothalamic hamartoma and mesial temporal lobe epilepsy.
However, very few cases of drug-resistant seizures of extratemporal origin treated by GKR have been reported.
A right-handed woman, born in1984 after uncomplicated pregnancy and delivery, of normal psychomotor development, started to experience complex partial seizures at the age of 12. She developed severe drug-resistant epilepsy at the age of 17, suffering from 5-6 seizures per month, with impairment of consciousness without automatisms, and aura with headache and nausea. Interictal word memory impairment adversely affected her education.
The preoperative work-up revealed seizures with right-sided frontal or frontotemporal origin. A lesion in the isthmus of cingulate gyrus on the right side detected on the MRI was stereotactically biopsied to be dysembryoplastic neuroepithelial tumor. Extensive investigation, including a stereotactic electroencephalography in 2004, indicated that the epileptogenic zone was confined to the boundaries of the lesion. Due to the location of the lesion, expected surgical difficulties and functional risks, she was referred to us and treated with GKR on September 2006 (age 21) with 24.0 Gy at 50% prescription isodose line.
After the initial expected transient increase of the auras, the seizures started to decrease significantly after six months and she had no more auras or seizures twelve months after GKR. She has been completely seizure and aura free (Engel IA) for more than two years now. The antiepileptic drugs are slowly being tapered and she is experiencing no side effects or complications related to GKR.
This is a retrospective study.
GKR seems to be a promising modality for treatment of medically refractory epilepsy originating from extratemporal areas that are either highly functional or centrally located.
Further studies with larger groups of patients and longer follow-up periods are warranted. Project Roles:
A. Samadi (), A. Melhaoui (), J. Isnard (), H. Isnard (), P. Chauvel (), J. Regis ()