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Deep brain stimulation in the treatment of pharmacoresistant epilepsy has gained increasing interest in recent years. Different targets are being chosen to modulate epileptic activity, including areas modifying seizure spread (eg, thalamus and subthalamic nucleus) and the primary epileptogenic focus (neocortical and hippocampal stimulation1 2). In patients undergoing thalamic stimulation, permanent effects of the implantation of stimulation electrodes have been reported in the treatment of Parkinson's disease, pain and epilepsy.3 We report here the antiepileptic effects of diagnostic depth electrode implantation in a patient with formerly pharmacoresistant epilepsy who has remained seizure free for more than 4 years after invasive recordings without subsequent epilepsy surgery.
This 37-year-old woman was admitted to our hospital with a history of focal epileptic seizures since the age of 27 years. Habitual seizures consisted of a cephalic aura and complex partial seizures with behavioural arrest and manual automatisms; seizure frequency was 1 every 5–7 days. Secondarily generalised tonic–clonic seizures had occurred only three times. Pharmacotherapy with maximally tolerable doses of carbamazepine, valproate, phenytoin, oxcarbazepine, levetiracetam and lamotrigine in mono- and polytherapy was unable to control her complex partial seizures. She was thus considered a potential surgical candidate and underwent presurgical evaluation.
A comprehensive presurgical workup was performed, including high resolution MR imaging …
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