• Pablo E Saucedo-Alvarado, Ana Luisa Velasco, Gustavo Aguado-Carrillo, Manola Cuellar-Herrera, David Trejo-Martínez, Rene Márquez-Franco, and Francisco Velasco-Campos.
• 1Epilepsy Clinic and Unit for Stereotactic and Functional Neurosurgery, Mexico General Hospital "Dr. Eduardo Liceaga," Mexico City; and.
• J. Neurosurg. 2022 Sep 1; 137 (3): 768775768-775.

ObjectiveThe authors sought to determine the antiseizure effects of deep brain stimulation (DBS) of the parahippocampal cortex (PHC) for treatment of drug-resistant mesial temporal lobe epilepsy (MTLE).MethodsAfter a 3-month baseline period, 6 adult patients with drug-resistant MTLE and hippocampal sclerosis (HS) had stereoelectroencephalography (SEEG)-DBS electrodes implanted at the PHC for identification of the seizure onset zone (SOZ). Patients entered an 8-month, randomized, double-blind protocol for DBS, followed by a 12-month open-phase study. Monthly reports of seizure frequency were collected, with separate counting of focal seizures with or without awareness impairment (focal impaired awareness seizures [FIAS] or focal aware seizures [FAS], respectively) and focal evolving to bilateral generalized tonic clonic seizures (GTCS). Stimulation parameters were 130 Hz, 450 μsec, 2.5-3 V, and cyclic stimulation 1 minute on/4 minutes off.ResultsThe total seizure rate decrement during follow-up was 41% (CI 25%-56%), with better seizure control for GTCS (IQR 19%-20%) and FIAS (IQR 0%-16%), with FAS being less responsive (IQR 67%-236%). No neuropsychological deterioration was observed.ConclusionsPHC DBS induced important antiseizure effects in patients with incapacitating FIAS and GTCS, most likely through blocking the propagation of hippocampal-onset seizures. The PHC target can be easily and safely approached due to positioning away from vascular structures, and there was no evidence of DBS-induced cognitive deterioration.

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