Laser interstitial thermal therapy for the treatment of epilepsy: evidence to date

Shukla, Navika; Ho, Allen L.; Pendharkar, Arjun V; Sussman, Eric S; Halpern, Casey H.

doi:10.2147/ndt.s139544

Cited by 30 publications

(19 citation statements)

References 31 publications

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“…A history of prior laser ablative surgery would not preclude further open resection or repeat ablation procedure. Its safety and accuracy, in patients with difficult-to-localize seizures has been shown [ 83 ], and its efficacy has been reported as comparable to that of open surgery but with less morbidity [ 84 , 85 ] including in older patients [ 86 ]. Evidence suggests that selective surgical approaches for mesial temporal lobe epilepsy lower cognitive risks compared to the standard ATL.…”

Section: Epilepsy Surgerymentioning

confidence: 99%

Diagnosis and Surgical Treatment of Drug-Resistant Epilepsy

Anyanwu

Motamedi

2018

Brain Sciences

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Despite appropriate trials of at least two antiepileptic drugs, about a third of patients with epilepsy remain drug resistant (intractable; refractory). Epilepsy surgery offers a potential cure or significant improvement to those with focal onset drug-resistant seizures. Unfortunately, epilepsy surgery is still underutilized which might be in part because of the complexity of presurgical evaluation. This process includes classifying the seizure type, lateralizing and localizing the seizure onset focus (epileptogenic zone), confirming the safety of the prospective brain surgery in terms of potential neurocognitive deficits (language and memory functions), before devising a surgical plan. Each one of the above steps requires special tests. In this paper, we have reviewed the process of presurgical evaluation in patients with drug-resistant focal onset epilepsy.

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Section: Epilepsy Surgerymentioning

confidence: 99%

Diagnosis and Surgical Treatment of Drug-Resistant Epilepsy

Anyanwu

Motamedi

2018

Brain Sciences

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“…MRgLITT has been shown to be associated with shorter operative duration and reduced postoperative length of stay [47]. Correspondingly, patients in the present cohort had a mean length of stay of 1.3 days compared to 3.5 and 4 days for patients undergoing craniotomy and open surgical resection with and without the utilization of iMRI, respectively [20].…”

Section: Discussionmentioning

confidence: 80%

An Initial Cost-Effectiveness Analysis of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy in Pediatric Epilepsy Surgery

et al. 2020

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Introduction: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new technology that provides a clinically efficacious and minimally invasive alternative to conventional microsurgical resection. However, little data exist on how costs compare to traditional open surgery. The goal of this paper is to investigate the cost-effectiveness of MRgLITT in the treatment of pediatric epilepsy. Methods: We retrospectively analyzed the medical records of pediatric patients who underwent MRgLITT via the Visualase ® thermal therapy system (Medtronic, Inc., Minneapolis, MN, USA) between December 2013 and September 2017. Direct costs associated with preoperative, operative, and follow-up care were extracted. Benefit was calculated in quality-adjusted life years (QALYs), and the cost-effectiveness was derived from the discounted total direct costs over QALY. Sensitivity analysis on 4 variables was utilized to assess the validity of our results. Results: Twelve consecutive pediatric patients with medically refractory epilepsy underwent MRgLITT procedures. At the last postoperative follow-up, 8 patients were seizure free (Engel I, 66.7%), 2 demonstrated significant improvement (Engel II, 16.7%), and 2 patients showed worthwhile improvement (Engel III, 16.7%). The average cumulative discounted QALY was 2.11 over the lifetime of a patient. Adjusting for inflation, MRgLITT procedures had a cost-effectiveness of USD 22,211 per QALY. Our sensitivity analysis of cost variables is robust and supports the procedure to be costeffective. Conclusion: Our data suggests that MRgLITT may be a cost-effective alternative to traditional surgical resection in pediatric epilepsy surgery.

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“…Although open surgery is an effective method for seizure control, it is also associated with postoperative neurologic and cognitive deficit [27]. Currently, LITT has become increasingly used by many epilepsy surgery centers as a minimally invasive alternative to open surgery for patients with medically refractory epilepsy who may or may not be candidates for open surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Outcomes of Magnetic Resonance Imaging (MRI)-Guided Laser Interstitial Thermal Therapy (LITT) in the Treatment of Drug-Resistant Epilepsy: A Meta-Analysis

Xue

Chen

Sun³

2018

Med Sci Monit

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BackgroundDrug-resistant epilepsy is a common neurological disease in adults and children. This study aimed to undertake a systematic review of the literature with meta-analysis of the data from published studies to assess the effectiveness of magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (LITT) in treatment-resistant epilepsy.Material/MethodsThe study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, MEDLINE, and EMBASE databases were systematically searched for indexed publications in the English language up to May 2018. Data on the prevalence, outcome using the Engel Epilepsy Surgery Outcome Scale (Class I to IV), and postoperative complications were analyzed with 95% confidence intervals (CIs). The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the risk of bias in the included studies.ResultsSixteen published studies that included a total of 269 patients with treatment resistant epilepsy were identified. The prevalence of Engel Class I, II, III and IV were 61% (95% CI, 0.54–0.68; I2=14.5%; P=0.302), 12% (95% CI, 0.07–0.16; I2=86.8%; P=0.000), 16% (95% CI, 0.10–0.22; I2=3.0%; P=0.397), and 15% (95% CI, 0.08–0.22; I2=13.2%; P=0.330), respectively. The prevalence of postoperative complications was 24% (95% CI, 0.16–0.32; I2=0%; P=0.629).ConclusionsMeta-analysis of data from 16 studies that included 269 patients with treatment-resistant epilepsy showed that MRI-guided LITT significantly reduced the frequency of seizures and reduced postoperative complications, supporting the safety and effectiveness of MRI-guided LITT in the treatment of drug-resistant epilepsy.

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Laser interstitial thermal therapy for the treatment of epilepsy: evidence to date

Cited by 30 publications

References 31 publications

Diagnosis and Surgical Treatment of Drug-Resistant Epilepsy

Diagnosis and Surgical Treatment of Drug-Resistant Epilepsy

An Initial Cost-Effectiveness Analysis of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy in Pediatric Epilepsy Surgery

Postoperative Outcomes of Magnetic Resonance Imaging (MRI)-Guided Laser Interstitial Thermal Therapy (LITT) in the Treatment of Drug-Resistant Epilepsy: A Meta-Analysis

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