Radiosurgery for epilepsy: Systematic review and International Stereotactic Radiosurgery Society (ISRS) practice guideline

Aileen McGonigal; Arjun Sahgal; Antonio De Salles; Motohiro Hayashi; Marc Levivier; Lijun Ma; Roberto Martinez; Ian Paddick; Samuel Ryu; Ben J Slotman; Jean Régis

doi:10.1016/j.eplepsyres.2017.08.016

Radiosurgery for epilepsy: Systematic review and International Stereotactic Radiosurgery Society (ISRS) practice guideline

Epilepsy Res. 2017 Nov:137:123-131. doi: 10.1016/j.eplepsyres.2017.08.016. Epub 2017 Sep 20.

Authors

Aileen McGonigal¹, Arjun Sahgal², Antonio De Salles³, Motohiro Hayashi⁴, Marc Levivier⁵, Lijun Ma⁶, Roberto Martinez⁷, Ian Paddick⁸, Samuel Ryu⁹, Ben J Slotman¹⁰, Jean Régis¹¹

Affiliations

¹ Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes and CHU Timone, Service de Neurophysiologie Clinique, Assistance Publique des Hôpitaux de Marseille, Marseille 13005, France. Electronic address: aileen.mcgonigal@univ-amu.fr.
² Department of Radiation Oncology, University of Toronto, Odette Cancer Centre, Toronto, ON, Canada.
³ Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA; HCor Neuroscience, Sao Paulo, SP, Brazil.
⁴ Department of Neurosurgery, Tokyo Women's Medical University, Toyko, Japan.
⁵ Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
⁶ Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
⁷ Department Neurosurgery, Ruber Internacional Hospital, Madrid, Spain.
⁸ Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, UK.
⁹ Department of Radiation Oncology and Neurosurgery, Stony Brook University, Stony Brook, NY, USA.
¹⁰ Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
¹¹ Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes & CHU Timone Department of Functional Neurosurgery, Assistance Publique des Hôpitaux de Marseille, Marseille 13005, France.

PMID: 28939289
DOI: 10.1016/j.eplepsyres.2017.08.016

Abstract

Background: While there are many reports of radiosurgery for treatment of drug-resistant epilepsy, a literature review is lacking.

Objective: The aim of this systematic review is to summarize current literature on the use of stereotactic radiosurgery (RS) for treatment of epilepsy.

Methods: Literature search was performed using various combinations of the search terms "radiosurgery", "stereotactic radiosurgery", "Gamma Knife", "epilepsy" and "seizure", from 1990 until October 2015. Level of evidence was assessed according to the PRISMA guidelines.

Results: Fifty-five articles fulfilled inclusion criteria. Level 2 evidence (prospective studies) was available for the clinical indications of mesial temporal lobe epilepsy (MTLE) and hypothalamic hamartoma (HH) treated by Gamma Knife (GK) RS. For remaining indications including corpus callosotomy as palliative treatment, epilepsy related to cavernous malformation and extra-temporal epilepsy, only Level 4 data was available (case report, prospective observational study, or retrospective case series). No Level 1 evidence was available.

Conclusion: Based on level 2 evidence, RS is an efficacious treatment to control seizures in MTLE, possibly resulting in superior neuropsychological outcomes and quality of life metrics in selected subjects compared to microsurgery. RS has a better risk-benefit ratio for small hypothalamic hamartomas compared to surgical methods Delayed therapeutic effect resulting in ongoing seizures is associated with morbidity and mortality risk. Lack of level 1 evidence precludes the formation of guidelines at present.

Keywords: Callosotomy; Epilepsy; Gamma knife; Hamartoma; Radiosurgery.

Publication types

Practice Guideline
Review
Systematic Review

MeSH terms

Epilepsy / radiotherapy*
Humans
Radiosurgery*