Complementary effect of surgical resection and responsive brain stimulation in the treatment of bitemporal lobe epilepsy: A case report

We report a 39-year-old man with bilateral mesial temporal lobe epilepsy. He was implanted with a responsive brain stimulator (RNS System) with two depth electrodes placed in the bimesial temporal structures. After the implantation, his seizure frequency decreased by up to 50%. Electrocorticogram recorded by the RNS device revealed the right-sided predominance of seizure onset. He underwent a right temporal lobectomy, and his seizure significantly improved. After the RNS System was restarted 107 days after the temporal lobectomy, he has been seizure free for more than 1.5 years. However, the implanted device continued to record residual ictal activities at the posterior aspect of the right hippocampus and delivered electrical stimuli to suppress the seizure activities. Our report indicates the importance of electrocorticographic recordings by the RNS System to modify the treatment strategy and the complementary effect of surgical resection and brain stimulation in the treatment of epilepsy.