Responsive Neurostimulation for Bitemporal Epilepsy: Seizure Outcomes and Device-Related Complications
DOI:
https://doi.org/10.5281/zenodo.22310493Keywords:
Responsive neurostimulation, Bitemporal epilepsy, Mesial temporal lobe epilepsy, Drug-resistant epilepsy, Device complicationsAbstract
Background: Bitemporal epilepsy, with independent seizure onsets from both mesial temporal structures, excludes most patients
from curative resection. Objective: To synthesize evidence on responsive neurostimulation (RNS) for bitemporal epilepsy, covering seizure outcomes, comparison with resective and ablative alternatives, and device-related complications.
Methods: Narrative review of pivotal RNS trials, long-term follow-up studies, bitemporal-specific cohorts, comparative surgical
series, and safety analyses. Findings: Long-term RNS cohorts show seizure reduction growing over time, from roughly 44% at one year to 75% or more by nine years, with bilateral implants performing comparably to unilateral placement. Bitemporal-specific series report meaningful reduction, some seizure-free. Complications, chiefly infection and lead issues, affect a minority of implants.
Conclusions: RNS offers a durable, non-resective option for bitemporal epilepsy, with a favorable long-term trajectory and
acceptable safety, though seizure freedom remains less common than after unilateral resection.
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