Abstracts

Rationale: Brain stimulation has recently been expanded to the investigational treatment of medically intractable epilepsy. Much like movement disorders, the stimulation targets selected for epilepsy are based on past experience with stereotactic lesions. A meta-analysis of past studies of stereotactic lesions for epilepsy was performed to provide historical context and possible standardization for the approach to current and future attempts at treating epilepsy with brain stimulation. Methods: A Medline search was conducted for studies with the words epilepsy surgery and stereotactic. Results from patients with stereotactic brain lesions of various anatomical sites were standardized using the Engel outcome scale and entered into a database used for this meta-analysis. Results: The most common pathology treated with stereotactic lesions was temporal lobe epilepsy. Of the procedures used, hippocampotomy had the best seizure control outcome, followed by amygdalohippocampotomy and then amygdolotomy (p value less than .05, Kruskal-Wallis Tests). Less common procedures were also analyzed. Conclusions: Stereotactic lesions for medically intractable epilepsy are not as effective in seizure control as resective surgery, but have been effective in reducing or eliminating seizures. Hippocampotomy alone appears to have the best outcomes for temporal lobe epilepsy. These results warrant future investigation and support the efficacy of current brain stimulation targets.