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Laser ablation is effective for temporal lobe epilepsy with and without mesial temporal sclerosis if hippocampal seizure onsets are localized by stereoelectroencephalography
Author(s) -
Youngerman Brett E.,
Oh Justin Y.,
Anbarasan Deepti,
Billakota Santoshi,
Casadei Camilla H.,
Corrigan Emily K.,
Banks Garret P.,
Pack Alison M.,
Choi Hyunmi,
Bazil Carl W.,
Srinivasan Shraddha,
Bateman Lisa M.,
Schevon Catherine A.,
Feldstein Neil A.,
Sheth Sameer A.,
McKhann Guy M.
Publication year - 2018
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.14004
Subject(s) - stereoelectroencephalography , hippocampal sclerosis , epilepsy , temporal lobe , medicine , epilepsy surgery , magnetic resonance imaging , drug resistant epilepsy , ictal , surgery , anterior temporal lobectomy , odds ratio , radiofrequency thermocoagulation , anesthesia , radiology , trigeminal neuralgia , psychiatry
Summary Objective Selective laser amygdalohippocampotomy ( SLAH ) using magnetic resonance–guided laser interstitial thermal therapy ( MR g LITT ) is emerging as a treatment option for drug‐resistant mesial temporal lobe epilepsy ( MTLE ). SLAH is less invasive than open resection, but there are limited series reporting its safety and efficacy, particularly in patients without clear evidence of mesial temporal sclerosis ( MTS ). Methods We report seizure outcomes and complications in our first 30 patients who underwent SLAH for drug‐resistant MTLE between January 2013 and December 2016. We compare patients who required stereoelectroencephalography ( SEEG ) to confirm mesial temporal onset with those treated based on imaging evidence of MTS . Results Twelve patients with SEEG ‐confirmed, non‐ MTS MTLE and 18 patients with MRI ‐confirmed MTS underwent SLAH . MTS patients were older (median age 50 vs 30 years) and had longer standing epilepsy (median 40.5 vs 5.5 years) than non‐ MTS patients. Engel class I seizure freedom was achieved in 7 of 12 non‐ MTS patients (58%, 95% confidence interval [CI ] 30%‐86%) and 10 of 18 MTS patients (56%, 95% CI 33%‐79%), with no significant difference between groups (odds ratio [ OR] 1.12, 95% CI 0.26‐4.91, P = .88). Length of stay was 1 day for most patients (range 0‐3 days). Procedural complications were rare and without long‐term sequelae. Significance We report similar rates of seizure freedom following SLAH in patients with MTS and SEEG ‐confirmed, non‐ MTS MTLE . Consistent with early literature, these rates are slightly lower than typically observed with surgical resection (60%‐80%). However, SLAH is less invasive than open surgery, with shorter hospital stays and recovery, and severe procedural complications are rare. SLAH may be a reasonable first‐line surgical option for patients with both MTS and SEEG confirmed, non‐ MTS MTLE .