Acute Postoperative Seizures and Engel Class Outcome at 1 Year Postselective Laser Amygdalohippocampal Ablation for Mesial Temporal Lobe Epilepsy

Barkley, Ariana; Sullivan, Liam; Gibson, Alec W; Zalewski, Kody; Donald, Christine L. Mac; Barber, Jason; Hakimian, Shahin; Ojemann, Jeffrey G.; Hauptman, Jason S.

doi:10.1227/neu.0000000000002023

Cited by 4 publications

(3 citation statements)

References 48 publications

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“…Another analysis of 28 patients found that patients with Engel I outcomes had a higher percentage of PHG ablated, 42 and a recent study of 11 patients undergoing a two‐fiber approach to target the piriform and entorhinal cortex suggested improved outcomes 43 . Conversely, other studies have found no correlation with ablation of these regions and outcome 44,45 . Some centers now use two fibers including an oblique lateral entry point to cover the amygdala and entorhinal cortex.…”

Section: Discussionmentioning

confidence: 99%

Seizure onset patterns predict outcome after stereo‐electroencephalography‐guided laser amygdalohippocampotomy

Michalak

Greenblatt

et al. 2023

Epilepsia

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Objective Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (stereo‐EEG) may miss seizure onset elsewhere. We hypothesized that stereo‐EEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the 2‐year outcomes of patients who underwent single‐fiber SLAH after stereo‐EEG and evaluated whether stereo‐EEG SOPs predict postoperative seizure freedom. Methods This retrospective five‐center study included patients with or without mesial temporal sclerosis (MTS) who underwent stereo‐EEG followed by single‐fiber SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. An SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was 2‐year Engel I classification or recurrent seizures before then, stratified by SOP category. Results Fifty‐eight patients were included, with a mean follow‐up duration of 39 ± 12 months after SLAH. Overall 1‐, 2‐, and 3‐year Engel I seizure freedom probability was 54%, 36%, and 33%, respectively. Patients with SOPs, including low‐voltage fast activity or low‐frequency repetitive spiking, had a 46% 2‐year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log‐rank test, p = .00015). Significance Patients who underwent SLAH after stereo‐EEG had a low probability of seizure freedom at 2 years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between hippocampal seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.

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Section: Discussionmentioning

confidence: 99%

Seizure onset patterns predict outcome after stereo‐electroencephalography‐guided laser amygdalohippocampotomy

Michalak

Greenblatt

et al. 2023

Epilepsia

View full text Add to dashboard Cite

show abstract

“…42 Conversely, other studies have found no correlation with ablation of these regions and outcome. 43,44 Some centers now use two fibers including an oblique lateral entry point to cover the amygdala and entorhinal cortex. Although the results of our primary analysis did not change when we excluded patients who had an altered or incomplete ablation, we did not perform quantitative analysis of ablation structures and volumes.…”

Section: Discussionmentioning

confidence: 99%

Seizure onset patterns predict outcome after stereotactic electroencephalography-guided laser amygdalohippocampotomy

Michalak

Greenblatt

et al. 2022

Preprint

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Objective: Stereotactic laser amygdalohippocampotomy (SLAH) is an appealing option for patients with temporal lobe epilepsy, who often require intracranial monitoring to confirm mesial temporal seizure onset. However, given limited spatial sampling, it is possible that stereotactic electroencephalography (sEEG) may miss seizure onset elsewhere. We hypothesized that sEEG seizure onset patterns (SOPs) may differentiate between primary onset and secondary spread and predict postoperative seizure control. In this study, we characterized the two-year outcomes of patients who underwent single-probe SLAH after sEEG and evaluated whether sEEG SOPs predict postoperative seizure freedom. Methods: This retrospective five-center study included patients with or without mesial temporal sclerosis (MTS) who underwent sEEG followed by single probe SLAH between August 2014 and January 2022. Patients with causative hippocampal lesions apart from MTS or for whom the SLAH was considered palliative were excluded. A SOP catalogue was developed based on literature review. The dominant pattern for each patient was used for survival analysis. The primary outcome was two-year Engel I classification or recurrent seizures before then, stratified by SOP category. Results: 58 patients were included with a mean follow-up duration of 39 ± 12 months after SLAH. Overall one-, two, and three-year Engel I seizure freedom probability was 54%, 36%, and 33% respectively. Patients with SOPs including low voltage fast activity or low frequency repetitive spiking had a 46% two-year seizure freedom probability, compared to 0% for patients with alpha or theta frequency repetitive spiking or theta or delta frequency rhythmic slowing (log rank test, p = 0.00015). Significance: Patients who underwent SLAH after sEEG had a low probability of seizure freedom at two years, but SOPs successfully predicted seizure recurrence in a subset of patients. This study provides proof of concept that SOPs distinguish between seizure onset and spread and supports using SOPs to improve selection of SLAH candidates.

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“…LITT was performed using the Visualase MRI-guided laser ablation system (Medtronic) by 3 neurosurgeons. 10 Clinical data and outcomes were assessed through database query, chart review of clinical encounters, and direct communication with patients and community neurologists as applicable. All outcomes were determined from the time of LITT.…”

Section: Methodsmentioning

confidence: 99%

Epilepsy-Related Mortality After Laser Interstitial Thermal Therapy in Patients With Drug-Resistant Epilepsy

et al. 2023

Self Cite

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Objectives:To study the incidence of sudden unexpected death in epilepsy (SUDEP) after laser interstitial thermal therapy (LITT) for drug-resistant epilepsy (DRE).Methods:Prospective observational study of consecutive patients treated with LITT between 2013-2021. The primary outcome was the occurrence of SUDEP during post-operative follow-up. Surgical outcome was classified according to the Engel scale.Results:There were 5 deaths including 4 SUDEP among 135 patients with a median follow-up duration of 3.5 (range 0.1-9.0) years and a total of 501.3 person-years at risk. The estimated incidence of SUDEP was 8.0 (95% CI 2.2-20.4) per 1000 person-years. Three SUDEP deaths occurred in patients with poor seizure outcomes, whereas 1 patient was seizure-free. Compared to pooled historical data, SUDEP occurred at a higher rate than in cohorts treated with resective surgery and similar to non-surgical controls.Discussion:SUDEP occurred early and late after mesial temporal LITT. The SUDEP rate was comparable to rates reported in epilepsy surgery candidates who did not receive intervention. These findings reinforce targeting seizure freedom to decrease SUDEP risk, including early consideration for further intervention.Classification of evidence:This study provides Class IV evidence that LITT is not effective in reducing SUDEP incidence in patients with DRE.

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Acute Postoperative Seizures and Engel Class Outcome at 1 Year Postselective Laser Amygdalohippocampal Ablation for Mesial Temporal Lobe Epilepsy

Cited by 4 publications

References 48 publications

Seizure onset patterns predict outcome after stereo‐electroencephalography‐guided laser amygdalohippocampotomy

Seizure onset patterns predict outcome after stereo‐electroencephalography‐guided laser amygdalohippocampotomy

Seizure onset patterns predict outcome after stereotactic electroencephalography-guided laser amygdalohippocampotomy

Epilepsy-Related Mortality After Laser Interstitial Thermal Therapy in Patients With Drug-Resistant Epilepsy

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