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Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy
Author(s) -
Kang Joon Y.,
Wu Chengyuan,
Tracy Joseph,
Lorenzo Matthew,
Evans James,
Nei Maromi,
Skidmore Christopher,
Mintzer Scott,
Sharan Ashwini D.,
Sperling Michael R.
Publication year - 2016
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.13284
Subject(s) - temporal lobe , parahippocampal gyrus , anterior temporal lobectomy , hippocampal sclerosis , epilepsy , medicine , hippocampus , magnetic resonance imaging , entorhinal cortex , surgery , radiology , psychiatry
Summary Objective To describe mesial temporal lobe ablated volumes, verbal memory, and surgical outcomes in patients with medically intractable mesial temporal lobe epilepsy ( mTLE ) treated with magnetic resonance imaging ( MRI )–guided stereotactic laser interstitial thermal therapy (Li TT ). Methods We prospectively tracked seizure outcome in 20 patients at Thomas Jefferson University Hospital with drug‐resistant m TLE who underwent MRI ‐guided Li TT from December 2011 to December 2014. Surgical outcome was assessed at 6 months, 1 year, 2 years, and at the most recent visit. Volume‐based analysis of ablated mesial temporal structures was conducted in 17 patients with mesial temporal sclerosis (MTS) and results were compared between the seizure‐free and not seizure‐free groups. Results Following Li TT , proportions of patients who were free of seizures impairing consciousness (including those with auras only) are as follows: 8 of 15 patients (53%, 95% confidence interval [ CI ] 30.1–75.2%) after 6 months, 4 of 11 patients (36.4%, 95% CI 14.9–64.8%) after 1 year, 3 of 5 patients (60%, 95% CI 22.9–88.4%) at 2‐year follow‐up. Median follow‐up was 13.4 months after Li TT (range 1.3 months to 3.2 years). Seizure outcome after Li TT suggests an all or none response. Four patients had anterior temporal lobectomy ( ATL ) after Li TT ; three are seizure‐free. There were no differences in total ablated volume of the amygdalohippocampus complex or individual volumes of hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, and fusiform gyrus between seizure‐free and non–seizure‐free patients. Contextual verbal memory performance was preserved after Li TT , although decline in noncontextual memory task scores were noted. Significance We conclude that MRI ‐guided stereotactic Li TT is a safe alternative to ATL in patients with medically intractable mTLE. Individualized assessment is warranted to determine whether the reduced odds of seizure freedom are worth the reduction in risk, discomfort, and recovery time. Larger prospective studies are needed to confirm our preliminary findings, and to define optimal ablation volume and ideal structures for ablation.