Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study.
Publication/Presentation Date
11-1-2023
Abstract
BACKGROUND: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown.
METHODS: This multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed.
RESULTS: Engel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year.
CONCLUSIONS: MRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.
Volume
94
Issue
11
First Page
879
Last Page
886
ISSN
1468-330X
Published In/Presented At
Youngerman, B. E., Banu, M. A., Khan, F., McKhann, G. M., Schevon, C. A., Jagid, J. R., Cajigas, I., Theodotou, C. B., Ko, A., Buckley, R., Ojemann, J. G., Miller, J. W., Laxton, A. W., Couture, D. E., Popli, G. S., Buch, V. P., Halpern, C. H., Le, S., Sharan, A. D., Sperling, M. R., … Wu, C. (2023). Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study. Journal of neurology, neurosurgery, and psychiatry, 94(11), 879–886. https://doi.org/10.1136/jnnp-2022-330979
Disciplines
Medicine and Health Sciences
PubMedID
37336643
Department(s)
Department of Surgery
Document Type
Article