Resident University of California San Francisco San Francisco, California, United States
Introduction: Treatment of epileptogenic foci within the eloquent peri-Rolandic region (pre- and post-central gyri) is challenging. Advances in surgical techniques and implantable neuromodulation devices have broadened the available treatment options. We aimed to assess the benefits and risks of various treatment options, namely resection and responsive neurostimulation (RNS), on treating peri-Rolandic epilepsy.
Methods: We retrospectively studied all consecutive patients who underwent intracranial seizure monitoring from 2013 to 2021. We studied demographic and imaging variables, stimulation results, seizure outcomes, and neurological function at various stages of recovery.
Results: 22 patients encompassing 25 procedures were included in this study. 12 of the patients had non-lesional MRIs with surgical intervention involving the dominant hemisphere. 9 patients underwent peri-Rolandic resections, and 11 patients received peri-Rolandic RNS. The rest had a combination of non-peri-Rolandic resection, multiple subpial transection, and peri-Rolandic RNS. When comparing resection against RNS cohorts, more patients who elected for resection had failed prior surgical interventions. All resection patients had a neurological deficit at discharge compared to none who received RNS. Resection cohort had higher rates of seizure-freedom (Engel I: 78% for resection vs 27% for RNS). 9/11 RNS patients had greater than 50% reduction in seizure-frequency with an overall seizure reduction of 72% at 1 year follow-up. Almost all patients with neurological deficits experienced significant functional recovery over time.
Conclusion : Resection of peri-Rolandic seizure foci can result in seizure-freedom with predetermined neurological morbidity that improves over time. RNS can result in significant seizure-reduction without morbidity. Treatment selection should be tailored based on risk-benefit analysis and patient preference.
