A comprehensive analysis of hearing preservation after radiosurgery for vestibular schwannoma

Journal of Neurosurgery

Volumn 112, Issue 4, 2010, Pages 851-859

  Yang, Isaac ^a   Sughrue, Michael E ^a   Han, Seunggu J ^a   Aranda, Derick ^a   Pitts, Lawrence H ^a   Cheung, Steven W ^a   Parsa, Andrew T ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

Gamma Knife; Hearing preservation; Radiosurgery; Vestibular schwannoma

Indexed keywords

AGE DISTRIBUTION; ARTICLE; FOLLOW UP; GAMMA KNIFE RADIOSURGERY; HEARING; HUMAN; NEURILEMOMA; OUTCOME ASSESSMENT; PHYSICIAN; PRIORITY JOURNAL; PROGNOSIS; RADIATION DOSE; RISK; SYSTEMATIC REVIEW; TUMOR VOLUME; VESTIBULAR SCHWANNOMA;

ADULT; AGED; FOLLOW-UP STUDIES; HEARING; HEARING LOSS; HUMANS; MIDDLE AGED; MORBIDITY; NEUROMA, ACOUSTIC; POSTOPERATIVE COMPLICATIONS; PROGNOSIS; RADIATION DOSAGE; RADIOSURGERY; RISK FACTORS; SEVERITY OF ILLNESS INDEX; YOUNG ADULT;

EID: 77950680477     PISSN: 00223085     EISSN: 19330693     Source Type: Journal    
DOI: 10.3171/2009.8.JNS0985     Document Type: Article

References (101)

1. Andrews DW, Suarez O, Goldman HW, Downes MB, Bednarz G, Corn BW, et al: Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys 50:1265-1278, 2001
2. Barker FG II, Carter BS: Synthesizing medical evidence: systematic reviews and metaanalyses. Neurosurg Focus 19(4):E5, 2005
3. Battista RA, Wiet RJ: Stereotactic radiosurgery for acoustic neuromas: a survey of the American Neurotology Society. Am J Otol 21:371-381, 2000 (Pubitemid 30305035)
4. Bertalanffy A, Dietrich W, Aichholzer M, Brix R, Ertl A, Heimberger K, et al: Gamma knife radiosurgery of acoustic neurinomas. Acta Neurochir (Wien) 143:689-695, 2001 (Pubitemid 32718842)
5. Chang SD, Adler JR Jr, Hancock SL: Clinical uses of radiosurgery. Oncology (Williston Park) 12:1181-1188, 1191-1192, 1998
6. Chang SD, Gibbs IC, Sakamoto GT, Lee E, Oyelese A, Adler JR Jr: Staged stereotactic irradiation for acoustic neuroma. Neurosurgery 56:1254-1263, 2005
7. Chin LS, Lazio BE, Biggins T, Amin P: Acute complications following gamma knife radiosurgery are rare. Surg Neurol 53:498-502, 2000 (Pubitemid 30386902)
8. Chopra R, Kondziolka D, Niranjan A, Lunsford LD, Flickinger JC: Long-term follow-up of acoustic schwannoma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 68:845-851, 2007 (Pubitemid 46818737)
9. Chung HT, Ma R, Toyota B, Clark B, Robar J, McKenzie M: Audiologic and treatment outcomes after linear accelerator-based stereotactic irradiation for acoustic neuroma. Int J Radiat Oncol Biol Phys 59:1116-1121, 2004 (Pubitemid 38834305)
10. Chung WY, Liu KD, Shiau CY, Wu HM, Wang LW, Guo WY, et al: Gamma knife surgery for vestibular schwannoma: 10-year experience of 195 cases. J Neurosurg 102 (Suppl):87-96, 2005 (Pubitemid 44783931)
11. Combs SE, Thilmann C, Debus J, Schulz-Ertner D: Long-term outcome of stereotactic radiosurgery (SRS) in patients with acoustic neuromas. Int J Radiat Oncol Biol Phys 64:1341-1347, 2006
12. Combs SE, Volk S, Schulz-Ertner D, Huber PE, Thilmann C, Debus J: Management of acoustic neuromas with fractionated stereotactic radiotherapy (FSRT): long-term results in 106 patients treated in a single institution. Int J Radiat Oncol Biol Phys 63:75-81, 2005 (Pubitemid 41583544)
13. de Ipolyi AR, Yang I, Buckley A, Barbaro NM, Cheung SW, Parsa AT: Fluctuating response of a cystic vestibular schwannoma to radiosurgery: case report. Neurosurgery 62:E1164-1165, 2008
14. Delbrouck C, Hassid S, Massager N, Choufani G, David P, Devriendt D, et al: Preservation of hearing in vestibular schwannomas treated by radiosurgery using Leksell Gamma Knife: preliminary report of a prospective Belgian clinical study. Acta Otorhinolaryngol Belg 57:197-204, 2003 (Pubitemid 38009120)
15. Doherty JK, Friedman RA: Controversies in building a management algorithm for vestibular schwannomas. Curr Opin Otolaryngol Head Neck Surg 14:305-313, 2006
16. Flickinger JC, Kondziolka D, Lunsford LD: Dose and diameter relationships for facial, trigeminal, and acoustic neuropathies following acoustic neuroma radiosurgery. Radiother Oncol 41:215-219, 1996 (Pubitemid 27019952)
17. Flickinger JC, Kondziolka D, Niranjan A, Lunsford LD: Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods. J Neurosurg 94:1-6, 2001 (Pubitemid 32799464)
18. Flickinger JC, Kondziolka D, Niranjan A, Maitz A, Voynov G, Lunsford LD: Acoustic neuroma radiosurgery with marginal tumor doses of 12 to 13 Gy. Int J Radiat Oncol Biol Phys 60:225-230, 2004 (Pubitemid 39165489)
19. Flickinger JC, Lunsford LD, Linskey ME, Duma CM, Kondzi-olka D: Gamma knife radiosurgery for acoustic tumors: multivariate analysis of four year results. Radiother Oncol 27:91-98, 1993
20. Foote KD, Friedman WA, Buatti JM, Meeks SL, Bova FJ, Ku-bilis PS: Analysis of risk factors associated with radiosurgery for vestibular schwannoma. J Neurosurg 95:440-449, 2001 (Pubitemid 32781496)
21. Foote RL, Coffey RJ, Swanson JW, Harner SG, Beatty CW, Kline RW, et al: Stereotactic radiosurgery using the gamma knife for acoustic neuromas. Int J Radiat Oncol Biol Phys 32:1153-1160, 1995
22. Franco-Vidal V, Songu M, Blanchet H, Barreau X, Darrouzet V: Intracochlear hemorrhage after gamma knife radiosurgery. Otol Neurotol 28:240-244, 2007 (Pubitemid 46175129)
23. Friedman WA, Foote KD: Linear accelerator-based radiosurgery for vestibular schwannoma. Neurosurg Focus 14(5):e2, 2003
24. Fuss M, Debus J, Lohr F, Huber P, Rhein B, Engenhart-Cabillic R, et al: Conventionally fractionated stereotactic radiotherapy (FSRT) for acoustic neuromas. Int J Radiat Oncol Biol Phys 48:1381-1387, 2000
25. Harsh GR, Thornton AF, Chapman PH, Bussiere MR, Rabi-nov JD, Loeffer JS: Proton beam stereotactic radiosurgery of vestibular schwannomas. Int J Radiat Oncol Biol Phys 54: 35-44, 2002
26. Hasegawa T, Fujitani S, Katsumata S, Kida Y, Yoshimoto M, Koike J: Stereotactic radiosurgery for vestibular schwanno-mas: analysis of 317 patients followed more than 5 years. Neu rosurgery 57:257-265, 2005
27. Hasegawa T, Kida Y, Kobayashi T, Yoshimoto M, Mori Y, Yoshida J: Long-term outcomes in patients with vestibular schwannomas treated using gamma knife surgery: 10-year follow up. J Neurosurg 102:10-16, 2005 (Pubitemid 43186690)
28. Hempel JM, Hempel E, Wowra B, Schichor C, Muacevic A, Riederer A: Functional outcome after gamma knife treatment in vestibular schwannoma. Eur Arch Otorhinolaryngol 263:714-718, 2006 (Pubitemid 44060973)
29. Hirato M, Inoue H, Nakamura M, Ohye C, Hirato J, Shibazaki T, et al: Gamma knife radiosurgery for acoustic schwannoma: early effects and preservation of hearing. Neurol Med Chir (Tokyo) 35:737-741, 1995
30. Hirato M, Inoue H, Zama A, Ohye C, Shibazaki T, Andou Y Gamma Knife radiosurgery for acoustic schwannoma: effects of low radiation dose and functional prognosis. Stereotact Funct Neurosurg 66 (Suppl 1): 134-141, 1996 (Pubitemid 27064611)
31. Huang CF, Tu HT, Lo HK, Wang KL, Liu WS: Radiosurgery for vestibular schwannomas. J Chin Med Assoc 68:315-320, 2005
32. Hudgins WR: Patients' attitude about outcomes and the role of gamma knife radiosurgery in the treatment of vestibular schwannomas. Neurosurgery 34:459-465, 1994
33. Inoue HK: Low-dose radiosurgery for large vestibular schwannomas: long-term results of functional preservation. J Neurosurg 102 (Suppl): 111-113, 2005
34. Ito K, Kurita H, Sugasawa K, Mizuno M, Sasaki T: Analyses of neuro-otological complications after radiosurgery for acoustic neurinomas. Int J Radiat Oncol Biol Phys 39:983-988, 1997 (Pubitemid 27506148)
35. Ito K, Kurita H, Sugasawa K, Okuno T, Mizuno M, Sasaki T: Neuro-otological fndings after radiosurgery for acoustic neurinomas. Arch Otolaryngol Head Neck Surg 122:1229-1233, 1996 (Pubitemid 26374851)
36. Ito K, Shin M, Matsuzaki M, Sugasawa K, Sasaki T: Risk factors for neurological complications after acoustic neurinoma radiosurgery: refnement from further experiences. Int J Radiat Oncol Biol Phys 48:75-80, 2000 (Pubitemid 30488215)
37. Iwai Y, Yamanaka K, Shiotani M, Uyama T: Radiosurgery for acoustic neuromas: results of low-dose treatment. Neurosurgery 53:282-288, 2003 (Pubitemid 36950905)
38. Kamerer DB, Lunsford LD, Moller M: Gamma knife: an alternative treatment for acoustic neurinomas. Ann Otol Rhinol Laryngol 97:631-635, 1988
39. Kamiryo T, Yamamoto M, Barfod BE, Urakawa Y: Dose absorbed by normal brainstem and optic apparatus in gamma knife surgery for ten or more metastasis, in Kondziolka D (ed): Radiosurgery. Basel: Karger, 2004, Vol 5, pp 77-81
40. Karpinos M, Teh BS, Zeck O, Carpenter LS, Phan C, Mai WY, et al: Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 54:1410-1421, 2002
41. Kaylie DM, McMenomey SO: Microsurgery vs gamma knife radiosurgery for the treatment of vestibular schwannomas. Arch Otolaryngol Head Neck Surg 129:903-906, 2003
42. Kida Y, Kobayashi T, Tanaka T, Mori Y: Radiosurgery for bilateral neurinomas associated with neurofbromatosis type 2. Surg Neurol 53:383-390, 2000
43. Koh ES, Millar BA, Menard C, Michaels H, Heydarian M, Ladak S, et al: Fractionated stereotactic radiotherapy for acoustic neuroma: single-institution experience at The Princess Margaret Hospital. Cancer 109:1203-1210, 2007
44. Kondziolka D, Lunsford LD: Preservation of hearing in acoustic neurinoma surgery. J Neurosurg 78:154-156, 1993
45. Kondziolka D, Lunsford LD, McLaughlin MR, Flickinger JC: Long-term outcomes after radiosurgery for acoustic neuromas. N Engl J Med 339:1426-1433, 1998
46. Kondziolka D, Subach BR, Lunsford LD, Bissonette DJ, Flickinger JC: Outcomes after gamma knife radiosurgery in solitary acoustic tumors and neurofbromatosis Type 2. Neurosurg Focus 5(3):e2, 1998
47. Lassaletta L, Fontes L, Melcon E, Sarria MJ, Gavilan J: Hearing preservation with the retrosigmoid approach for vestibular schwannoma: myth or reality? Otolaryngol Head Neck Surg 129:397-401, 2003
48. Lind CR, Costello SA, Mathur S, Law AJ: Stereotactic radiosurgery in New Zealand. N Z Med J 114:182-184, 2001
49. Linskey ME: Hearing preservation in vestibular schwannoma stereotactic radiosurgery: what really matters? J Neurosurg 109:129-136, 2008
50. Linskey ME: Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate. J Neurosurg 93 (Suppl 3): 90-95, 2000
51. Linskey ME, Johnstone PA, O'Leary M, Goetsch S: Radiation exposure of normal temporal bone structures during stereot-actically guided gamma knife surgery for vestibular schwannomas. J Neurosurg 98:800-806, 2003
52. Linskey ME, Lunsford LD, Flickinger JC: Radiosurgery for acoustic neurinomas: early experience. Neurosurgery 26: 736-745, 1990
53. Linskey ME, Lunsford LD, Flickinger JC: Tumor control after stereotactic radiosurgery in neurofbromatosis patients with bilateral acoustic tumors. Neurosurgery 31:829-839, 1992
54. Lunsford LD, Kamerer DB, Flickinger JC: Stereotactic radiosurgery for acoustic neuromas. Arch Otolaryngol Head Neck Surg 116:907-909, 1990
55. Lunsford LD, Linskey ME: Stereotactic radiosurgery in the treatment of patients with acoustic tumors. Otolaryngol Clin North Am 25:471-491, 1992
56. Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D: Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 102 (Suppl): 195-199, 2005
57. Lyman GH, Kuderer NM: The strengths and limitations of meta-analyses based on aggregate data. BMC Med Res Meth-odol 5:14, 2005
58. Massager N, Nissim O, Delbrouck C, Devriendt D, David P, Desmedt F, et al: Role of intracanalicular volumetric and dosimetric parameters on hearing preservation after vestibular schwannoma radiosurgery. Int J Radiat Oncol Biol Phys 64: 1331-1340, 2006
59. Meijer OW, Vandertop WP, Baayen JC, Slotman BJ: Single-fraction vs. fractionated linac-based stereotactic radiosurgery for vestibular schwannoma: a single-institution study. Int J Radiat Oncol Biol Phys 56:1390-1396, 2003
60. Meijer OW, Wolbers JG, Baayen JC, Slotman BJ: Fractionated stereotactic radiation therapy and single high-dose radiosurgery for acoustic neuroma: early results of a prospective clinical study. Int J Radiat Oncol Biol Phys 46:45-49, 2000
61. Mendenhall WM, Friedman WA, Bova FJ: Linear accelerator-based stereotactic radiosurgery for acoustic schwannomas. Int J Radiat Oncol Biol Phys 28:803-810, 1994
62. Mendenhall WM, Friedman WA, Buatti JM, Bova FJ: Preliminary results of linear accelerator radiosurgery for acoustic schwannomas. J Neurosurg 85:1013-1019, 1996
63. Miller RC, Foote RL, Coffey RJ, Sargent DJ, Gorman DA, Schomberg PJ, et al: Decrease in cranial nerve complications after radiosurgery for acoustic neuromas: a prospective study of dose and volume. Int J Radiat Oncol Biol Phys 43:305-311, 1999
64. Muacevic A, Jess-Hempen A, Tonn JC, Wowra B: Results of outpatient gamma knife radiosurgery for primary therapy of acoustic neuromas. Acta Neurochir Suppl 91:75-78, 2004
65. Myrseth E, Moller P, Pedersen PH, Vassbotn FS, Wentzel-Lar-sen T, Lund-Johansen M: Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery. Neurosurgery 56:927-935, 2005
66. Niranjan A, Lunsford LD, Flickinger JC, Maitz A, Kondziolka D: Can hearing improve after acoustic tumor radiosurgery? Neurosurg Clin N Am 10:305-315, 1999
67. Niranjan A, Lunsford LD, Flickinger JC, Maitz A, Kondziolka D: Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery. Neurosurgery 45:753-755, 1999
68. Noren G: Long-term complications following gamma knife radiosurgery of vestibular schwannomas. Stereotact Funct Neurosurg 70 (Suppl 1):65-73, 1998
69. Ogunrinde OK, Lunsford DL, Kondziolka DS, Bissonette DJ, Flickinger JC: Cranial nerve preservation after stereotactic radiosurgery of intracanalicular acoustic tumors. Stereotact Funct Neurosurg 64 (Suppl 1): 87-97, 1995
70. Ottaviani F, Neglia CB, Ventrella L, Giugni E, Motti E Hearing loss and changes in transient evoked otoacoustic emissions after gamma knife radiosurgery for acoustic neurinomas. Arch Otolaryngol Head Neck Surg 128:1308-1312, 2002
71. Paek SH, Chung HT, Jeong SS, Park CK, Kim CY, Kim JE, et al: Hearing preservation after gamma knife stereotactic radiosurgery of vestibular schwannoma. Cancer 104:580-590, 2005
72. Pellet W, Regis J, Roche PH, Delsanti C: Relative indications for radiosurgery and microsurgery for acoustic schwannoma. Adv Tech Stand Neurosurg 28:227-284, 2003
73. Petit JH, Hudes RS, Chen TT, Eisenberg HM, Simard JM, Chin LS: Reduced-dose radiosurgery for vestibular schwannomas. Neurosurgery 49:1299-1307, 2001
74. Poen JC, Golby AJ, Forster KM, Martin DP, Chinn DM, Hancock SL, et al: Fractionated stereotactic radiosurgery and preservation of hearing in patients with vestibular schwannoma: a preliminary report. Neurosurgery 45:1299-1307, 1999
75. Pogodzinski MS, Harner SG, Link MJ: Patient choice in treatment of vestibular schwannoma. Otolaryngol Head Neck Surg 130:611-616, 2004
76. Pollack AG, Marymont MH, Kalapurakal JA, Kepka A, Sathia-seelan V, Chandler JP Acute neurological complications following gamma knife surgery for vestibular schwannoma. Case report. J Neurosurg 103:546-551, 2005
77. Pollock BE, Driscoll CL, Foote RL, Link MJ, Gorman DA, Bauch CD, et al: Patient outcomes after vestibular schwan-noma management: a prospective comparison of microsurgi cal resection and stereotactic radiosurgery. Neurosurgery 59: 77-85, 2006
78. Pollock BE, Lunsford LD, Kondziolka D, Flickinger JC, Bissonette DJ, Kelsey SF, et al: Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery. Neurosurgery 36:215-219, 1995
79. Prasad D, Steiner M, Steiner L: Gamma surgery for vestibular schwannoma. J Neurosurg 92:745-759, 2000
80. Ramsay HA, Luxford WM: Treatment of acoustic tumours in elderly patients: is surgery warranted? J Laryngol Otol 107: 295-297, 1993
81. Regis J, Delsanti C, Roche P, Soumare O, Dufour H, Porcheron D, et al: [Preservation of hearing function in the radiosurgical treatment of unilateral vestibular schwannomas. Preliminary results.] Neurochirurgie 48:471-478, 2002 (Fr)
82. Regis J, Pellet W, Delsanti C, Dufour H, Roche PH, Thomassin JM, et al: Functional outcome after gamma knife surgery or microsurgery for vestibular schwannomas. J Neurosurg 97: 1091-1100, 2002
83. Rowe JG, Radatz MW, Walton L, Hampshire A, Seaman S, Ke-meny AA: Gamma knife stereotactic radiosurgery for unilateral acoustic neuromas. J Neurol Neurosurg Psychiatry 74: 1536-1542, 2003
84. Rowe JG, Radatz MW, Walton L, Soanes T, Rodgers J, Ke-meny AA: Clinical experience with gamma knife stereotactic radiosurgery in the management of vestibular schwannomas secondary to type 2 neurofbromatosis. J Neurol Neurosurg Psychiatry 74:1288-1293, 2003
85. Rutten I, Baumert BG, Seidel L, Kotolenko S, Collignon J, Kaschten B, et al: Long-term follow-up reveals low toxicity of radiosurgery for vestibular schwannoma. Radiother Oncol 82:83-89, 2007
86. Sekhar LN, Gormley WB, Wright DC: The best treatment for vestibular schwannoma (acoustic neuroma): microsurgery or radiosurgery? Am J Otol 17:676-679, 1996
87. Shin YJ, Lapeyre-Mestre M, Gafsi I, Cognard C, Deguine O, Tremoulet M, et al: Neurotological complications after radiosurgery versus conservative management in acoustic neuromas: a systematic review-based study. Acta Otolaryngol 123:59-64, 2003
88. Shoshan Y, Wygoda M, Umansky F Stereotactic radiosurgery and fractionated stereotactic radiotherapy: background, defnitions, applications. Isr Med Assoc J 7:597-599, 2005
89. Smith MC, Ryken TC, Buatti JM: Radiotoxicity after confor-mal radiation therapy for benign intracranial tumors. Neurosurg Clin N Am 17:169-180, 2006
90. Spiegelmann R, Gofman J, Alezra D, Pfeffer R Radiosurgery for acoustic neurinomas (vestibular schwannomas). Isr Med Assoc J 1:8-13, 1999
91. Spiegelmann R, Lidar Z, Gofman J, Alezra D, Hadani M, Pfeffer R: Linear accelerator radiosurgery for vestibular schwan noma. J Neurosurg 94:7-13, 2001 (Pubitemid 32799465)
92. Sughrue M, Yang I, Aranda D, Lobo K, Pitts LH, Cheung SW, et al: The natural history of untreated sporadic vestibular schwannomas: a comprehensive review of hearing outcomes. Clinical article. J Neurosurg. Published online ahead of print June 19, 2009. DOI: 10.3171/2009.4 JNS08895
93. Suh JH, Barnett GH, Sohn JW, Kupelian PA, Cohen BH: Results of linear accelerator-based stereotactic radiosurgery for recurrent and newly diagnosed acoustic neuromas. Int J Cancer 90: 145-151, 2000
94. Thomsen J, Tos M, Borgesen SE: Gamma knife: hydrocephalus as a complication of stereotactic radiosurgical treatment of an acoustic neuroma. Am J Otol 11:330-333, 1990
95. Unger F, Walch C, Haselsberger K, Papaefthymiou G, Trummer M, Eustacchio S, et al: Radiosurgery of vestibular schwannomas: a minimally invasive alternative to microsurgery. Acta Neurochir (Wien) 141:1281-1286, 1999 (Pubitemid 30042874)
96. Unger F, Walch C, Papaefthymiou G, Feichtinger K, Trummer M, Pendl G: Radiosurgery of residual and recurrent vestibular schwannomas. Acta Neurochir (Wien) 144:671-677, 2002 (Pubitemid 34969549)
97. Unger F, Walch C, Schröttner O, Eustacchio S, Sutter B, Pendl G: Cranial nerve preservation after radiosurgery of vestibular schwannomas. Acta Neurochir Suppl 84:77-83, 2002
98. Wiet RJ, Micco AG, Bauer GP Complications of the gamma knife. Arch Otolaryngol Head Neck Surg 122:414-416, 1996
99. Yamamoto M, Hagiwara S, Ide M, Jimbo M, Hirai T, Nakamura Y: Radiosurgery for acoustic neurinoma with rapid growth and relatively high staining indexes for proliferating cell nuclear antigen and MIB-1. Neurol Med Chir (Tokyo) 36:241-245, 1996
100. Yang CC, Ting J, Wu X, Markoe A: Dose volume histogram analysis of the gamma knife radiosurgery treating twenty-five metastatic intracranial tumors. Stereotact Funct Neurosurg 70 (Suppl 1):41-49, 1998
101. Yang I, Barbaro NM: Advances in the radiosurgical treatment of epilepsy. Epilepsy Curr 7:31-35, 2007