Magnetic Resonance–Guided Laser Interstitial Thermal Therapy for Mesial Temporal Epilepsy: A Case Series Analysis of Outcomes and Complications at 2-Year Follow-Up

Iahn Cajigas, Andres M Kanner, Ramses Ribot, Amanda M. Casabella, Anil Mahavadi, Walter Jermakowicz, Samir Sur, Carlos Millan, Anita Saporta, Merredith Lowe, Naymee Velez-Ruiz, Gustavo Rey, George M. Ibrahim, Michael E. Ivan, Jonathan Jagid

Research output: Contribution to journalArticle

Abstract

Background: Laser interstitial thermal therapy (LITT) presents an important new minimally invasive tool in the management of drug-resistant mesial temporal epilepsy (MTE). However, because of its relative novelty, not much is known about long-term seizure freedom rates. The objective of this study was to evaluate the postsurgical seizure outcome following LITT after a minimum follow-up period of 2 years. Methods: Medical records of all patients who underwent LITT for MTE from 2013 to 2018 at our comprehensive epilepsy center under a single surgeon were retrospectively reviewed. Data related to demographics, presurgical evaluations, and seizure outcome were compared between seizure-free (SF) and non–seizure-free (NSF) patients. Results: In all, 26 patients were identified with at least 2 years of follow-up. Mean age was 43.8 years ± 11.6 years, and 46.2% were female. After a mean follow-up time of 42.9 months (range, 24.3–58.8 months), 61.5% (16/26) were free of disabling seizures, and 26.9% (7/26) had only rare disabling seizures. Whereas seizure-freedom rates between patients with and without mesial temporal sclerosis (MTS) were not statistically different (68% vs. 43%, P = 0.23), NSF patients without MTS had a shorter median time to first seizure than did NSF patients with MTS (0.55 month vs. 10 months, log-rank test P = 0.007). Postoperative complications occurred in 2 patients (7.7%), consisting of 1 permanent and 1 transient homonymous hemianopia. Conclusions: LITT appears to be a safe and effective initial surgical option for treatment-resistant MTE. Among patients who have seizures after treatment, those without MTS appear to have seizures earlier than those with MTS.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StatePublished - Jan 1 2019

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Epilepsy
Seizures
Lasers
Hot Temperature
Sclerosis
Therapeutics
Hemianopsia
Medical Records
Demography
Pharmaceutical Preparations

Keywords

  • Engel outcome
  • Laser interstitial thermal therapy
  • Magnetic resonance–guided laser interstitial thermal therapy
  • Mesial temporal epilepsy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Magnetic Resonance–Guided Laser Interstitial Thermal Therapy for Mesial Temporal Epilepsy : A Case Series Analysis of Outcomes and Complications at 2-Year Follow-Up. / Cajigas, Iahn; Kanner, Andres M; Ribot, Ramses; Casabella, Amanda M.; Mahavadi, Anil; Jermakowicz, Walter; Sur, Samir; Millan, Carlos; Saporta, Anita; Lowe, Merredith; Velez-Ruiz, Naymee; Rey, Gustavo; Ibrahim, George M.; Ivan, Michael E.; Jagid, Jonathan.

In: World neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Cajigas, Iahn ; Kanner, Andres M ; Ribot, Ramses ; Casabella, Amanda M. ; Mahavadi, Anil ; Jermakowicz, Walter ; Sur, Samir ; Millan, Carlos ; Saporta, Anita ; Lowe, Merredith ; Velez-Ruiz, Naymee ; Rey, Gustavo ; Ibrahim, George M. ; Ivan, Michael E. ; Jagid, Jonathan. / Magnetic Resonance–Guided Laser Interstitial Thermal Therapy for Mesial Temporal Epilepsy : A Case Series Analysis of Outcomes and Complications at 2-Year Follow-Up. In: World neurosurgery. 2019.
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abstract = "Background: Laser interstitial thermal therapy (LITT) presents an important new minimally invasive tool in the management of drug-resistant mesial temporal epilepsy (MTE). However, because of its relative novelty, not much is known about long-term seizure freedom rates. The objective of this study was to evaluate the postsurgical seizure outcome following LITT after a minimum follow-up period of 2 years. Methods: Medical records of all patients who underwent LITT for MTE from 2013 to 2018 at our comprehensive epilepsy center under a single surgeon were retrospectively reviewed. Data related to demographics, presurgical evaluations, and seizure outcome were compared between seizure-free (SF) and non–seizure-free (NSF) patients. Results: In all, 26 patients were identified with at least 2 years of follow-up. Mean age was 43.8 years ± 11.6 years, and 46.2{\%} were female. After a mean follow-up time of 42.9 months (range, 24.3–58.8 months), 61.5{\%} (16/26) were free of disabling seizures, and 26.9{\%} (7/26) had only rare disabling seizures. Whereas seizure-freedom rates between patients with and without mesial temporal sclerosis (MTS) were not statistically different (68{\%} vs. 43{\%}, P = 0.23), NSF patients without MTS had a shorter median time to first seizure than did NSF patients with MTS (0.55 month vs. 10 months, log-rank test P = 0.007). Postoperative complications occurred in 2 patients (7.7{\%}), consisting of 1 permanent and 1 transient homonymous hemianopia. Conclusions: LITT appears to be a safe and effective initial surgical option for treatment-resistant MTE. Among patients who have seizures after treatment, those without MTS appear to have seizures earlier than those with MTS.",
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AU - Kanner, Andres M

AU - Ribot, Ramses

AU - Casabella, Amanda M.

AU - Mahavadi, Anil

AU - Jermakowicz, Walter

AU - Sur, Samir

AU - Millan, Carlos

AU - Saporta, Anita

AU - Lowe, Merredith

AU - Velez-Ruiz, Naymee

AU - Rey, Gustavo

AU - Ibrahim, George M.

AU - Ivan, Michael E.

AU - Jagid, Jonathan

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AB - Background: Laser interstitial thermal therapy (LITT) presents an important new minimally invasive tool in the management of drug-resistant mesial temporal epilepsy (MTE). However, because of its relative novelty, not much is known about long-term seizure freedom rates. The objective of this study was to evaluate the postsurgical seizure outcome following LITT after a minimum follow-up period of 2 years. Methods: Medical records of all patients who underwent LITT for MTE from 2013 to 2018 at our comprehensive epilepsy center under a single surgeon were retrospectively reviewed. Data related to demographics, presurgical evaluations, and seizure outcome were compared between seizure-free (SF) and non–seizure-free (NSF) patients. Results: In all, 26 patients were identified with at least 2 years of follow-up. Mean age was 43.8 years ± 11.6 years, and 46.2% were female. After a mean follow-up time of 42.9 months (range, 24.3–58.8 months), 61.5% (16/26) were free of disabling seizures, and 26.9% (7/26) had only rare disabling seizures. Whereas seizure-freedom rates between patients with and without mesial temporal sclerosis (MTS) were not statistically different (68% vs. 43%, P = 0.23), NSF patients without MTS had a shorter median time to first seizure than did NSF patients with MTS (0.55 month vs. 10 months, log-rank test P = 0.007). Postoperative complications occurred in 2 patients (7.7%), consisting of 1 permanent and 1 transient homonymous hemianopia. Conclusions: LITT appears to be a safe and effective initial surgical option for treatment-resistant MTE. Among patients who have seizures after treatment, those without MTS appear to have seizures earlier than those with MTS.

KW - Engel outcome

KW - Laser interstitial thermal therapy

KW - Magnetic resonance–guided laser interstitial thermal therapy

KW - Mesial temporal epilepsy

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