{"id":25929,"date":"2021-03-29T08:00:56","date_gmt":"2021-03-29T06:00:56","guid":{"rendered":"https:\/\/mjn.cat\/?p=25929"},"modified":"2021-03-26T14:28:40","modified_gmt":"2021-03-26T13:28:40","slug":"epilepsia-tecniques-minimament-invasives","status":"publish","type":"post","link":"https:\/\/mjn.cat\/ca\/epilepsia-cat\/epilepsia-tecniques-minimament-invasives\/","title":{"rendered":"T\u00e8cniques m\u00ednimament invasives pel tractament de l\u2019epil\u00e8psia refract\u00e0ria"},"content":{"rendered":"[vc_row type=\u00bbin_container\u00bb full_screen_row_position=\u00bbmiddle\u00bb column_margin=\u00bbdefault\u00bb column_direction=\u00bbdefault\u00bb column_direction_tablet=\u00bbdefault\u00bb column_direction_phone=\u00bbdefault\u00bb scene_position=\u00bbcenter\u00bb text_color=\u00bbdark\u00bb text_align=\u00bbleft\u00bb row_border_radius=\u00bbnone\u00bb row_border_radius_applies=\u00bbbg\u00bb overlay_strength=\u00bb0.3&#8243; gradient_direction=\u00bbleft_to_right\u00bb shape_divider_position=\u00bbbottom\u00bb bg_image_animation=\u00bbnone\u00bb][vc_column column_padding=\u00bbpadding-5-percent\u00bb column_padding_tablet=\u00bbinherit\u00bb column_padding_phone=\u00bbinherit\u00bb column_padding_position=\u00bbleft-right\u00bb background_color_opacity=\u00bb1&#8243; background_hover_color_opacity=\u00bb1&#8243; column_shadow=\u00bbnone\u00bb column_border_radius=\u00bbnone\u00bb column_link_target=\u00bb_self\u00bb gradient_direction=\u00bbleft_to_right\u00bb overlay_strength=\u00bb0.3&#8243; width=\u00bb1\/1&#8243; tablet_width_inherit=\u00bbdefault\u00bb tablet_text_alignment=\u00bbdefault\u00bb phone_text_alignment=\u00bbdefault\u00bb column_border_width=\u00bbnone\u00bb column_border_style=\u00bbsolid\u00bb bg_image_animation=\u00bbnone\u00bb][vc_row_inner column_margin=\u00bbdefault\u00bb column_direction=\u00bbdefault\u00bb column_direction_tablet=\u00bbdefault\u00bb column_direction_phone=\u00bbdefault\u00bb text_align=\u00bbleft\u00bb][vc_column_inner column_padding=\u00bbpadding-5-percent\u00bb column_padding_tablet=\u00bbinherit\u00bb column_padding_phone=\u00bbinherit\u00bb column_padding_position=\u00bbleft-right\u00bb background_color_opacity=\u00bb1&#8243; background_hover_color_opacity=\u00bb1&#8243; column_shadow=\u00bbnone\u00bb column_border_radius=\u00bbnone\u00bb column_link_target=\u00bb_self\u00bb gradient_direction=\u00bbleft_to_right\u00bb overlay_strength=\u00bb0.3&#8243; width=\u00bb1\/1&#8243; tablet_width_inherit=\u00bbdefault\u00bb column_border_width=\u00bbnone\u00bb column_border_style=\u00bbsolid\u00bb bg_image_animation=\u00bbnone\u00bb][vc_column_text]\u00c1ngel Aledo Serrano \u00e9s neur\u00f2leg i est\u00e0 especialitzat en Epil\u00e8psia pedi\u00e0trica i d\u2019adults a l\u2019<a href=\"https:\/\/www.ruberinternacional.es\/es\/cuadro-medico\/equipos\/equipo-dr-oriol-franch-ubia\/dr-angel-aledo-serrano\" target=\"blank\" rel=\"noopener noreferrer\">Hospital Ruber Internacional<\/a> (Madrid), col\u00b7laborant tamb\u00e9 a la <a href=\"https:\/\/www.corachan.com\/ca\/dr-angel-aledo-serrano_64641\" target=\"blank\" rel=\"noopener noreferrer\">Cl\u00ednica Corachan<\/a> (Barcelona). Est\u00e0 especialitzat en el tractament de l\u2019epil\u00e8psia refractaria amb diferents enfocaments: cirurgia de epil\u00e8psia per epil\u00e8psies focals refract\u00e0ries, ter\u00e0pies de precisi\u00f3 per epil\u00e8psies gen\u00e8riques i encefalopaties del desenvolupament, o ter\u00e0pies immunomoduladores per epil\u00e8psies autoimmunes, entre altres. Realitza una amplia tasca docent col\u00b7laborant amb universitats i divulgativa en xarxes socials, col\u00b7laborant a m\u00e9s amb nombroses associacions de pacients com assessor m\u00e8dic i cient\u00edfic.[\/vc_column_text][divider line_type=\u00bbFull Width Line\u00bb line_thickness=\u00bb2&#8243; divider_color=\u00bbdefault\u00bb animate=\u00bbyes\u00bb custom_height=\u00bb50&#8243;][\/vc_column_inner][\/vc_row_inner][vc_row_inner equal_height=\u00bbyes\u00bb content_placement=\u00bbmiddle\u00bb column_margin=\u00bbdefault\u00bb column_direction=\u00bbdefault\u00bb column_direction_tablet=\u00bbdefault\u00bb column_direction_phone=\u00bbdefault\u00bb text_align=\u00bbleft\u00bb][vc_column_inner column_padding=\u00bbpadding-5-percent\u00bb column_padding_tablet=\u00bbinherit\u00bb column_padding_phone=\u00bbinherit\u00bb column_padding_position=\u00bbleft-right\u00bb background_color_opacity=\u00bb1&#8243; background_hover_color_opacity=\u00bb1&#8243; column_shadow=\u00bbnone\u00bb column_border_radius=\u00bbnone\u00bb column_link_target=\u00bb_self\u00bb gradient_direction=\u00bbleft_to_right\u00bb overlay_strength=\u00bb0.3&#8243; width=\u00bb1\/1&#8243; tablet_width_inherit=\u00bbdefault\u00bb column_border_width=\u00bbnone\u00bb column_border_style=\u00bbsolid\u00bb bg_image_animation=\u00bbnone\u00bb][vc_column_text]\n<h2>T\u00e8cniques m\u00ednimament invasives pel tractament de l\u2019epil\u00e8psia refract\u00e0ria<\/h2>\n[\/vc_column_text][vc_column_text]Publicat per: <a href=\"https:\/\/es.linkedin.com\/in\/angelaledo\" target=\"blank\" rel=\"noopener noreferrer\"><u>Dr. \u00c1ngel Aledo Serrano<\/u><\/a>[\/vc_column_text][vc_column_text]La cirurgia de l&#8217;epil\u00e8psia \u00e9s un tractament \u00fatil i segur per a una gran proporci\u00f3 de persones amb epil\u00e8psia focal que no estan controlades amb f\u00e0rmacs antiepil\u00e8ptics. L&#8217;epil\u00e8psia refract\u00e0ria representa al voltant del 30% del total, i s&#8217;estima, per exemple, que a Espanya hi ha unes 130.000 persones amb epil\u00e8psia refract\u00e0ria. No obstant aix\u00f2, tot i que s&#8217;ha demostrat que \u00e9s una millora significativa en la qualitat de vida dels pacients, \u00e9s una estrat\u00e8gia de tractament poc utilitzada. Una de les raons d&#8217;aquesta \u00abinfrautilitzaci\u00f3\u00bb \u00e9s la por a les conseq\u00fc\u00e8ncies de realitzar una neurocirurgia oberta. En els \u00faltims anys s&#8217;han desenvolupat diferents t\u00e8cniques que, mitjan\u00e7ant procediments m\u00ednimament invasius, es poden utilitzar com a alternativa a la cirurgia oberta en pacients seleccionats. Algunes d&#8217;aquestes t\u00e8cniques s\u00f3n:<br \/>\n[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner column_margin=\u00bbdefault\u00bb column_direction=\u00bbdefault\u00bb column_direction_tablet=\u00bbdefault\u00bb column_direction_phone=\u00bbdefault\u00bb text_align=\u00bbleft\u00bb][vc_column_inner column_padding=\u00bbpadding-5-percent\u00bb column_padding_tablet=\u00bbinherit\u00bb column_padding_phone=\u00bbinherit\u00bb column_padding_position=\u00bbleft-right\u00bb background_color_opacity=\u00bb1&#8243; background_hover_color_opacity=\u00bb1&#8243; column_shadow=\u00bbnone\u00bb column_border_radius=\u00bbnone\u00bb column_link_target=\u00bb_self\u00bb gradient_direction=\u00bbleft_to_right\u00bb overlay_strength=\u00bb0.3&#8243; width=\u00bb1\/1&#8243; tablet_width_inherit=\u00bbdefault\u00bb column_border_width=\u00bbnone\u00bb column_border_style=\u00bbsolid\u00bb bg_image_animation=\u00bbnone\u00bb][vc_column_text]\n<h3>Termocoagulaci\u00f3 de radiofreq\u00fc\u00e8ncia guiada per l&#8217;estereo-electroencefalografia (E-EEG):<\/h3>\n[\/vc_column_text][vc_column_text]La termocoagulaci\u00f3 o termoablaci\u00f3 amb el\u00e8ctrodes intracerebrals, per la seva efic\u00e0cia i seguretat, s&#8217;ha imposat com una de les principals opcions de tractament m\u00ednimament invasives per a pacients amb epil\u00e8psia focal en centres de refer\u00e8ncia europeus i americans. Consisteix en la implantaci\u00f3 d&#8217;el\u00e8ctrodes en la profunditat del cervell que permeten delimitar la zona epileptog\u00e8nica (\u00e0rea cerebral on es generen crisis epil\u00e8ptiques) mitjan\u00e7ant un registre electroencefalograma, similar al de superf\u00edcie amb EEG habitual, per\u00f2 que s&#8217;implanta amb m\u00e9s precisi\u00f3 dins de l&#8217;escor\u00e7a cerebral. Aquesta implantaci\u00f3 es realitza amb un procediment no invasiu, amb el\u00e8ctrodes de menys d&#8217;1 mm de gruix i petits forats al crani. Un cop identificada la zona on s&#8217;originen les crisis, gr\u00e0cies a l&#8217;aplicaci\u00f3 de l&#8217;energia t\u00e8rmica, es pot produir una petita lesi\u00f3 a la zona seleccionada per prevenir la generaci\u00f3 de la crisis. [\/vc_column_text][image_with_animation image_url=\u00bb25913&#8243; animation=\u00bbFade In\u00bb hover_animation=\u00bbnone\u00bb alignment=\u00bb\u00bb border_radius=\u00bbnone\u00bb box_shadow=\u00bbnone\u00bb image_loading=\u00bbdefault\u00bb max_width=\u00bb100%\u00bb max_width_mobile=\u00bbdefault\u00bb][vc_column_text]Al voltant del 50% dels pacients sotmesos a aquest tractament tenen una millora significativa en la freq\u00fc\u00e8ncia de convulsions. A m\u00e9s, la resposta inicial a la termocoagulaci\u00f3 prediu un bon resultat si posteriorment \u00e9s necess\u00e0ria la cirurgia de resecci\u00f3 oberta. La taxa de complicacions \u00e9s molt baixa i dep\u00e8n en gran mesura de l&#8217;experi\u00e8ncia de l&#8217;equip de neurologia-neurocirurgia que la duu a terme. A m\u00e9s, no es requereix anest\u00e8sia per realitzar ablaci\u00f3, la qual cosa permet monitoritzar l&#8217;efic\u00e0cia i seguretat del tractament \u00aben temps real\u00bb.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner column_margin=\u00bbdefault\u00bb column_direction=\u00bbdefault\u00bb column_direction_tablet=\u00bbdefault\u00bb column_direction_phone=\u00bbdefault\u00bb text_align=\u00bbleft\u00bb][vc_column_inner column_padding=\u00bbpadding-5-percent\u00bb column_padding_tablet=\u00bbinherit\u00bb column_padding_phone=\u00bbinherit\u00bb column_padding_position=\u00bbleft-right\u00bb background_color_opacity=\u00bb1&#8243; background_hover_color_opacity=\u00bb1&#8243; column_shadow=\u00bbnone\u00bb column_border_radius=\u00bbnone\u00bb column_link_target=\u00bb_self\u00bb gradient_direction=\u00bbleft_to_right\u00bb overlay_strength=\u00bb0.3&#8243; width=\u00bb1\/1&#8243; tablet_width_inherit=\u00bbdefault\u00bb column_border_width=\u00bbnone\u00bb column_border_style=\u00bbsolid\u00bb bg_image_animation=\u00bbnone\u00bb][vc_column_text]\n<h3>L\u00e0ser amb termoablaci\u00f3 <i>(laser ablation)<\/i><\/h3>\n[\/vc_column_text][vc_column_text]L&#8217;ablaci\u00f3 l\u00e0ser \u00e9s una t\u00e8cnica moderna que ha arribat a revolucionar el tractament de l&#8217;epil\u00e8psia juntament amb altres t\u00e8cniques m\u00ednimament invasives. \u00c9s una t\u00e8cnica en la qual s&#8217;insereix una sonda a la zona que provoca crisis epil\u00e8ptiques i s&#8217;aplica energia t\u00e8rmica per lesionar aquest teixit. T\u00e9 l&#8217;avantatge que permet el seguiment del proc\u00e9s amb resson\u00e0ncia magn\u00e8tica (el procediment es realitza dins de l&#8217;estaci\u00f3 de resson\u00e0ncia magn\u00e8tica, amb el pacient anestesiat i adormit). Aix\u00f2 la converteix en una opci\u00f3 per a pacients amb petites lesions cerebrals ben delimitades. T\u00e9 una alta efic\u00e0cia per fer que els pacients estiguin lliures de crisi si els candidats s\u00f3n seleccionats b\u00e9, permetent tamb\u00e9 menys complicacions quir\u00fargiques, amb alta hospital\u00e0ria molt primerenca (en 24 o 48 hores). De vegades la termocoagulaci\u00f3 es pot utilitzar inicialment i despr\u00e9s l&#8217;ablaci\u00f3 l\u00e0ser, si el primer no ha estat efectiu per\u00f2 la regi\u00f3 d&#8217;inici s&#8217;ha localitzat amb est\u00e8reo-EEG. Algunes lesions profundes es tracten millor amb l\u00e0ser que la cirurgia convencional, a causa de la seva precisi\u00f3 i capacitat de tractar zones profundes sense danyar les \u00e0rees superficials.[\/vc_column_text][image_with_animation image_url=\u00bb25908&#8243; animation=\u00bbFade In\u00bb hover_animation=\u00bbnone\u00bb alignment=\u00bb\u00bb border_radius=\u00bbnone\u00bb box_shadow=\u00bbnone\u00bb image_loading=\u00bbdefault\u00bb max_width=\u00bb100%\u00bb max_width_mobile=\u00bbdefault\u00bb][\/vc_column_inner][\/vc_row_inner][vc_row_inner column_margin=\u00bbdefault\u00bb column_direction=\u00bbdefault\u00bb column_direction_tablet=\u00bbdefault\u00bb column_direction_phone=\u00bbdefault\u00bb text_align=\u00bbleft\u00bb][vc_column_inner column_padding=\u00bbpadding-5-percent\u00bb column_padding_tablet=\u00bbinherit\u00bb column_padding_phone=\u00bbinherit\u00bb column_padding_position=\u00bbleft-right\u00bb background_color_opacity=\u00bb1&#8243; background_hover_color_opacity=\u00bb1&#8243; column_shadow=\u00bbnone\u00bb column_border_radius=\u00bbnone\u00bb column_link_target=\u00bb_self\u00bb gradient_direction=\u00bbleft_to_right\u00bb overlay_strength=\u00bb0.3&#8243; width=\u00bb1\/1&#8243; tablet_width_inherit=\u00bbdefault\u00bb column_border_width=\u00bbnone\u00bb column_border_style=\u00bbsolid\u00bb bg_image_animation=\u00bbnone\u00bb][vc_column_text]\n<h3>Radiocirugia amb Gamma Knife (GK):<\/h3>\n[\/vc_column_text][vc_column_text]La radiocirurgia d&#8217;estereotaxia implica una lesi\u00f3 per radiaci\u00f3 gamma d&#8217;una zona circumscrita del cervell. Hi ha m\u00faltiples indicacions per a l&#8217;aplicaci\u00f3 del Gamma Knife, incloent-hi els m\u00e9s estudiats s\u00f3n l&#8217;epil\u00e8psia secund\u00e0ria a hamartomes hipot\u00e0lems o per a pacients amb esclerosi hipocamp que no volen cirurgia oberta, per\u00f2 tamb\u00e9 \u00e9s \u00fatil en altres tipus de lesions, com les displ\u00e0sies corticals focals, especialment si es troben en zones \u00abarriscades\u00bb per a la cirurgia oberta. El seu principal desavantatge \u00e9s que l&#8217;efecte sobre el control de la crisi pot trigar entre 12 i 24 mesos a apar\u00e8ixer, per\u00f2 \u00e9s una t\u00e8cnica segura i indolora que no requereix que es realitzi l&#8217;hospitalitzaci\u00f3, de manera que el pacient pot tornar a casa el mateix dia de la seva realitzaci\u00f3.[\/vc_column_text][image_with_animation image_url=\u00bb25918&#8243; animation=\u00bbFade In\u00bb hover_animation=\u00bbnone\u00bb alignment=\u00bb\u00bb border_radius=\u00bbnone\u00bb box_shadow=\u00bbnone\u00bb image_loading=\u00bbdefault\u00bb max_width=\u00bb100%\u00bb max_width_mobile=\u00bbdefault\u00bb][\/vc_column_inner][\/vc_row_inner][vc_row_inner column_margin=\u00bbdefault\u00bb column_direction=\u00bbdefault\u00bb column_direction_tablet=\u00bbdefault\u00bb column_direction_phone=\u00bbdefault\u00bb text_align=\u00bbleft\u00bb][vc_column_inner column_padding=\u00bbpadding-5-percent\u00bb column_padding_tablet=\u00bbinherit\u00bb column_padding_phone=\u00bbinherit\u00bb column_padding_position=\u00bbleft-right\u00bb background_color_opacity=\u00bb1&#8243; background_hover_color_opacity=\u00bb1&#8243; column_shadow=\u00bbnone\u00bb column_border_radius=\u00bbnone\u00bb column_link_target=\u00bb_self\u00bb gradient_direction=\u00bbleft_to_right\u00bb overlay_strength=\u00bb0.3&#8243; width=\u00bb1\/1&#8243; tablet_width_inherit=\u00bbdefault\u00bb column_border_width=\u00bbnone\u00bb column_border_style=\u00bbsolid\u00bb bg_image_animation=\u00bbnone\u00bb][vc_column_text]\n<h3>Altres t\u00e8cniques: Estimulaci\u00f3 del Nervi Vagus, RNS (\u00abNeuroestimulaci\u00f3 Responsiva\u00bb) i Estimulador Trigeminal.<\/h3>\n[\/vc_column_text][vc_column_text]Tot i que les t\u00e8cniques pr\u00e8vies s\u00f3n t\u00e8cniques de curaci\u00f3, aquestes \u00faltimes s\u00f3n \u00abpal\u00b7liatives\u00bb, ja que no eliminen completament les convulsions del pacient. No obstant aix\u00f2, poden ser \u00fatils per reduir la intensitat de les crisis i, per exemple, les caigudes relacionades amb la crisi. Es basen en la implementaci\u00f3 de dispositius que detecten l&#8217;aparici\u00f3 de crisis i, aplicant un est\u00edmul el\u00e8ctric, eviten la seva propagaci\u00f3. El m\u00e9s utilitzat \u00e9s l&#8217;estimulador Nervi Vagus (fotografiat), que s&#8217;utilitza principalment per a pacients amb convulsions violentes amb risc de caiguda. El segon, menys utilitzat, implanta un generador al crani que, utilitzant el\u00e8ctrodes, envia polsos el\u00e8ctrics a una determinada zona del cervell en el moment en qu\u00e8 la crisi comen\u00e7a a desenvolupar-se. L&#8217;estimulaci\u00f3 trigeminal \u00e9s una opci\u00f3 que, tot i que no ha demostrat una efic\u00e0cia significativa en el control de la crisi, sembla millorar la qualitat de vida dels pacients que la porten.[\/vc_column_text][image_with_animation image_url=\u00bb25923&#8243; animation=\u00bbFade In\u00bb hover_animation=\u00bbnone\u00bb alignment=\u00bb\u00bb border_radius=\u00bbnone\u00bb box_shadow=\u00bbnone\u00bb image_loading=\u00bbdefault\u00bb max_width=\u00bb100%\u00bb max_width_mobile=\u00bbdefault\u00bb][\/vc_column_inner][\/vc_row_inner][vc_row_inner column_margin=\u00bbdefault\u00bb column_direction=\u00bbdefault\u00bb column_direction_tablet=\u00bbdefault\u00bb column_direction_phone=\u00bbdefault\u00bb text_align=\u00bbleft\u00bb][vc_column_inner column_padding=\u00bbpadding-5-percent\u00bb column_padding_tablet=\u00bbinherit\u00bb column_padding_phone=\u00bbinherit\u00bb column_padding_position=\u00bbleft-right\u00bb background_color_opacity=\u00bb1&#8243; background_hover_color_opacity=\u00bb1&#8243; column_shadow=\u00bbnone\u00bb column_border_radius=\u00bbnone\u00bb column_link_target=\u00bb_self\u00bb gradient_direction=\u00bbleft_to_right\u00bb overlay_strength=\u00bb0.3&#8243; width=\u00bb1\/1&#8243; tablet_width_inherit=\u00bbdefault\u00bb column_border_width=\u00bbnone\u00bb column_border_style=\u00bbsolid\u00bb bg_image_animation=\u00bbnone\u00bb][vc_column_text]\n<h3>Estimulaci\u00f3 cerebral profunda<\/h3>\n[\/vc_column_text][vc_column_text]Consisteix en l&#8217;estimulaci\u00f3 per radiofreq\u00fc\u00e8ncia d&#8217;el\u00e8ctrodes implantats amb estereotaxia en els nuclis de profunditat cerebral (nuclis t\u00e0lems). Tot i que la seva efectivitat en el control de crisis \u00e9s modesta, hi ha estudis que donen suport a la seva efic\u00e0cia en pacients amb epil\u00e8psia que no responen al tractament m\u00e8dic.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner column_margin=\u00bbdefault\u00bb column_direction=\u00bbdefault\u00bb column_direction_tablet=\u00bbdefault\u00bb column_direction_phone=\u00bbdefault\u00bb text_align=\u00bbleft\u00bb][vc_column_inner column_padding=\u00bbpadding-5-percent\u00bb column_padding_tablet=\u00bbinherit\u00bb column_padding_phone=\u00bbinherit\u00bb column_padding_position=\u00bbleft-right\u00bb background_color_opacity=\u00bb1&#8243; background_hover_color_opacity=\u00bb1&#8243; column_shadow=\u00bbnone\u00bb column_border_radius=\u00bbnone\u00bb column_link_target=\u00bb_self\u00bb gradient_direction=\u00bbleft_to_right\u00bb overlay_strength=\u00bb0.3&#8243; width=\u00bb1\/1&#8243; tablet_width_inherit=\u00bbdefault\u00bb column_border_width=\u00bbnone\u00bb column_border_style=\u00bbsolid\u00bb bg_image_animation=\u00bbnone\u00bb][vc_column_text]\n<h3>Bibliografia<\/h3>\n[\/vc_column_text][vc_column_text]\n<ul>\n<li>Chang EF, Englot DJ, Vadera S. Minimally invasive surgical approaches for temporal lobe epilepsy. Epilepsy Behav 2015: 47:24-33.<\/li>\n<li>Bourdillon P, Devaux B, Job-Chapron AS, Isnard J. SEEG-guided radiofrequency thermocoagulation. Clin Neurophysiol 2017. ********<\/li>\n<li>Cossu M, Cardinale F, Casaceli G et al. Stereo-EEG guided radiofrequency thermocoagulations. Epilepsia 2017; 58:66-72.<\/li>\n<li>McGonigal A, Sahgal A, De Salles A, et al. Radiosurgery for epilepsy: Systematic review and International Stereotactic Radiosurgery Society (ISRS) practice guideline. Epilepsy Res 2017******<\/li>\n<li>Castinetti F, Brue T, Morange I, Carron R, R\u00e9gis J. Gamma Knife radiosurgery for hypothalamic hamartoma preserves endocrine functions. Epilepsia 2017; 58:72-76.<\/li>\n<li>Prince E, Hakimian S, Ko AL, Ojeman JG, Kim MS, Miller JW. Laser Interstitial Thermal Therapy for Epilepsy. Curr Neurol Neurosci Rep 2017; 17-63.<\/li>\n<li>Donos C, Breier J, Friedman E, et al. Laser ablation for mesial temporal lobe epilepsy: Surgical and cognitive outcomes with and without mesial temporal sclerosis. Epilepsia 2018: 1-18.<\/li>\n<li>Kawai K, Tanaka T, Baba H, et al. Outcome of vagus nerve stimulation for drug-resistant epilepsy: the first three years of a prospective Japanese registry. Epileptic Disord 2017; 19:327-38.<\/li>\n<li>Soss J, Heck C, Murray D, et al. A prospective long-term study of external trigeminal nerve stimulation for drug-resistant epilepsy. Epilepsy Behav 2015; 42:44-47.<\/li>\n<li>Valent\u00edn A, Garc\u00eda Navarrete E, Chelvarajah R, et al. Deep brain stimulation of the centromedian thalamic nucleus for the treatment of generalized and frontal epilepsies. 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