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Radiosurgery versus open surgery for mesial temporal lobe epilepsy: The randomized, controlled ROSE trial
Author(s) -
Barbaro Nicholas M.,
Quigg Mark,
Ward Mariann M.,
Chang Edward F.,
Broshek Donna K.,
Langfitt John T.,
Yan Guofen,
Laxer Kenneth D.,
Cole Andrew J.,
Sneed Penny K.,
Hess Christopher P.,
Yu Wei,
Tripathi Manjari,
Heck Christianne N.,
Miller John W.,
Garcia Paul A.,
McEvoy Andrew,
Fountain Nathan B.,
Salanova Vincenta,
Knowlton Robert C.,
Bagić Anto,
Henry Thomas,
Kapoor Siddharth,
McKhann Guy,
Palade Adriana E.,
Reuber Markus,
Tecoma Evelyn
Publication year - 2018
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.14045
Subject(s) - medicine , radiosurgery , randomized controlled trial , epilepsy , confidence interval , temporal lobe , epilepsy surgery , quality of life (healthcare) , anterior temporal lobectomy , adverse effect , mesial temporal lobe epilepsy , surgery , radiation therapy , psychiatry , nursing
Summary Objective To compare stereotactic radiosurgery ( SRS ) versus anterior temporal lobectomy ( ATL ) for patients with pharmacoresistant unilateral mesial temporal lobe epilepsy ( MTLE ). Methods This randomized, single‐blinded, controlled trial recruited adults eligible for open surgery among 14 centers in the US A, UK, and India. Treatment was either SRS at 24 Gy to the 50% isodose targeting mesial structures, or standardized ATL . Outcomes were seizure remission (absence of disabling seizures between 25 and 36 months), verbal memory ( VM ), and quality of life ( QOL ) at 36‐month follow‐up. Results A total of 58 patients (31 in SRS , 27 in ATL ) were treated. Sixteen (52%) SRS and 21 (78%) ATL patients achieved seizure remission (difference between ATL and SRS = 26%, upper 1‐sided 95% confidence interval = 46%, P value at the 15% noninferiority margin = .82). Mean VM changes from baseline for 21 English‐speaking, dominant‐hemisphere patients did not differ between groups; consistent worsening occurred in 36% of SRS and 57% of ATL patients. QOL improved with seizure remission. Adverse events were anticipated cerebral edema and related symptoms for some SRS patients, and cerebritis, subdural hematoma, and others for ATL patients. Significance These data suggest that ATL has an advantage over SRS in terms of proportion of seizure remission, and both SRS and ATL appear to have effectiveness and reasonable safety as treatments for MTLE . SRS is an alternative to ATL for patients with contraindications for or with reluctance to undergo open surgery.