Laser interstitial thermal therapy (LITT): Seizure outcomes for refractory mesial temporal lobe epilepsy

Le, Scheherazade; Ho, Allen L.; Fisher, Robert S.; Miller, Kai J.; Henderson, Jaimie M.; Grant, Gerald A.; Meador, Kimford J.; Halpern, Casey H.

doi:10.1016/j.yebeh.2018.09.040

Cited by 66 publications

(48 citation statements)

References 20 publications

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“…6,9,12,16 Our findings, however, agree with recent studies, which have suggested that LITT is effective in properly selected patients with mTLE, regardless of isolated rHS. 6,9,12,16 Our findings, however, agree with recent studies, which have suggested that LITT is effective in properly selected patients with mTLE, regardless of isolated rHS.…”

Section: Patient Factorssupporting

confidence: 91%

“…The presence of rHS on MRI has been associated with favorable surgical outcomes. 6,9,12,16 Our findings, however, agree with recent studies, which have suggested that LITT is effective in properly selected patients with mTLE, regardless of isolated rHS. 11,17 In truth, the presence of rHS should not be viewed as a singular epilepsy phenotype, but rather an attribute of distinct mTLE subtypes.…”

Section: Patient Factorssupporting

confidence: 91%

“…[3][4][5][6][8][9][10][11][12] Unfortunately, without consideration of specific therapy location, which is subject to variability in patient anatomy and the surgery itself, these studies are limited in their ability to reliably report clinical outcomes. [3][4][5][6][8][9][10][11][12] Unfortunately, without consideration of specific therapy location, which is subject to variability in patient anatomy and the surgery itself, these studies are limited in their ability to reliably report clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…To date, small single-institution series have suggested that AHC LITT is a viable treatment for drug-resistant mTLE. [3][4][5][6][8][9][10][11][12] Unfortunately, without consideration of specific therapy location, which is subject to variability in patient anatomy and the surgery itself, these studies are limited in their ability to reliably report clinical outcomes. In this study, we have: (a) proposed a novel robust methodology using nonlinear normalization and statistical models to study complex brain therapies such as LITT for mTLE; (b) applied it to previously existing data in the largest and most comprehensive multicenter study to date; (c) demonstrated in 234 patients with at least 1-year follow-up that 58.0% achieved Engel I outcomes and 76.9% achieved either Engel I or II outcomes at the time of last follow-up; and (d) presented the first three-dimensional model of a favorable laser ablation zone.…”

Section: Discussionmentioning

confidence: 99%

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Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients

et al. 2019

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Objective Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) has reported seizure freedom rates between 36% and 78% with at least 1 year of follow‐up. Unfortunately, the lack of robust methods capable of incorporating the inherent variability of patient anatomy, the variability of the ablated volumes, and clinical outcomes have limited three‐dimensional quantitative analysis of surgical targeting and its impact on seizure outcomes. We therefore aimed to leverage a novel image‐based methodology for normalizing surgical therapies across a large multicenter cohort to quantify the effects of surgical targeting on seizure outcomes in LITT for mTLE. Methods This multicenter, retrospective cohort study included 234 patients from 11 centers who underwent LITT for mTLE. To investigate therapy location, all ablation cavities were manually traced on postoperative magnetic resonance imaging (MRI), which were subsequently nonlinearly normalized to a common atlas space. The association of clinical variables and ablation location to seizure outcome was calculated using multivariate regression and Bayesian models, respectively. Results Ablations including more anterior, medial, and inferior temporal lobe structures, which involved greater amygdalar volume, were more likely to be associated with Engel class I outcomes. At both 1 and 2 years after LITT, 58.0% achieved Engel I outcomes. A history of bilateral tonic‐clonic seizures decreased chances of Engel I outcome. Radiographic hippocampal sclerosis was not associated with seizure outcome. Significance LITT is a viable treatment for mTLE in patients who have been properly evaluated at a comprehensive epilepsy center. Consideration of surgical factors is imperative to the complete assessment of LITT. Based on our model, ablations must prioritize the amygdala and also include the hippocampal head, parahippocampal gyrus, and rhinal cortices to maximize chances of seizure freedom. Extending the ablation posteriorly has diminishing returns. Further work is necessary to refine this analysis and define the minimal zone of ablation necessary for seizure control.

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Section: Patient Factorssupporting

confidence: 91%

Section: Patient Factorssupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients

et al. 2019

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“…40 There were no differences in outcomes among groups with MTS and non-MTS in this and other studies. 6,39,40 Other studies reported Engel class I seizure freedom rates of 36.4% at 1 year (n = 20), 19 52% at 24 ± 11 months (n = 21), 35 and 62% at 18 ± 12 months (n = 30) 23 following SLAH for TLE. These results are comparable to the first RCT for TLE (n = 40 in the surgical arm and n = 40 in the medical arm), which reported that 58% of patients were without seizures impairing awareness and 38% were free of any seizures at 1 year following temporal lobectomy.…”

Section: Litt Versus Open Surgical Procedures For Rementioning

confidence: 98%

Inverse national trends of laser interstitial thermal therapy and open surgical procedures for refractory epilepsy: a Nationwide Inpatient Sample–based propensity score matching analysis

Sharma¹,

Ball²,

Alhourani³

et al. 2020

Neurosurgical Focus

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OBJECTIVESurgery for medically refractory epilepsy (RE) is an underutilized treatment modality, despite its efficacy. Laser interstitial thermal therapy (LITT), which is minimally invasive, is increasingly being utilized for a variety of brain lesions and offers comparable seizure outcomes. The aim of this study was to report the national trends of open surgical procedures for RE with the advent of LITT.METHODSData were extracted using the ICD-9/10 codes from the Nationwide Inpatient Sample (NIS, 2012–2016) in this retrospective study. Patients with a primary diagnosis of RE who underwent either open surgeries (lobectomy, partial lobectomy, and amygdalohippocampectomy) or LITT were included. Patient demographics, complications, hospital length of stay (LOS), discharge disposition, and index hospitalization costs were analyzed. Propensity score matching (PSM) was used to analyze outcomes.RESULTSA cohort of 128,525 in-hospital patients with RE was included and 5.5% (n = 7045) of these patients underwent either open surgical procedures (94.3%) or LITT (5.7%). LITT is increasingly being performed at a rate of 1.09 per 1000 epilepsy admissions/year, while open surgical procedures are decreasing at a rate of 10.4/1000 cases/year. The majority of procedures were elective (92%) and were performed at large-bed-size hospitals (86%). All LITT procedures were performed at teaching facilities and the majority were performed in the South (37%) and West (30%) regions. The median LOS was 1 day for the LITT cohort and 4 days for the open cohort. Index hospitalization charges were significantly lower following LITT compared to open procedures ($108,332 for LITT vs $124,012 for open surgery, p < 0.0001). LITT was associated with shorter median LOS, high likelihood of discharge home, and lower median index hospitalization charges compared to open procedures for RE on PSM analysis.CONCLUSIONSLITT is increasingly being performed in favor of open surgical procedures. LITT is associated with a shorter LOS, a higher likelihood of being discharged home, and lower index hospitalization charges compared to open procedures. LITT is a safe treatment modality in carefully selected patients with RE and offers an opportunity to increase the utilization of surgical treatment in patients who may be opposed to open surgery or have contraindications that preclude open surgery.

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Ferrous Disulfide‐Based Photothermal Nanocatalyst for NIR‐II Mild Hyperthermia‐Enhanced Chemodynamic Therapy of Temporal Lobe Epilepsy

Liu

Men

et al. 2022

Adv Materials Inter

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as drug-resistant epilepsy (DRE), represents a formidable challenge in the clinic with poor prognosis and heavy disease burden. [1] Resection or ablation of epileptogenic focus offers an important method for the treatment of focal DRE such as temporal lobe epilepsy (TLE). However, locoregional resective surgery is greatly impeded by postoperative complications and misconceptions. [2] Laser interstitial thermal therapy (LITT), which adopts 980 nm or 1064 nm second near-infrared (NIR-II) laser, can achieve comparable efficacy to traditional surgery while significantly reducing surgical complications, showing great prospects for photothermal therapy (PTT) of epilepsy. [3] However, the operating power of clinically approved PTT approaches including LITT is usually as high as 10 W. [4] Therefore, nonselective killing of lesions and surrounding healthy tissues is unavoidable. [4a,5] Photothermal agents (PTA) which could absorb light irradiation and exhibit photo-heat conversion effects substantially increase the selectivity of PTT. [5][6] Our previous study also revealed that polydopamine nanoparticles irradiated by 808 nm laser can precisely ablate the deep brain tissue without significant damage to the superficial tissues. [7] Despite great progress in the development of PTA, PTT relying solely on heating Photothermal therapy (PTT) has been approved clinically to ablate epileptogenic focus, while the clinical application of this approach is still hindered due to its limited selectivity and potential safety concerns related to extreme hyperthermia. Hypothermal PPT (HPTT) is a novel treatment modality employing mild hyperthermia to ablate abnormal cells, which has a distinctive advantage of minimal side effects on healthy tissues. The significantly elevated hydrogen peroxide (H 2 O 2 ) concentration in the epileptogenic zone provides a suitable microenvironment for selective chemodynamic therapy (CDT), which utilizes the Fenton reaction of H 2 O 2 and iron-based nanomaterials to generate cytotoxic free radicals. Herein, the authors report proof-ofconcept evidence that HPTT and CDT can be successfully integrated to ablate epileptogenic focus. A photothermal nanocatalyst ferrous disulfide nanoplatform is prepared for CDT of epilepsy. More importantly, the CDT efficacy is augmented by the second near-infrared irradiation-induced hyperthermia, leading to synergistic HPTT and CDT therapy. In vivo studies on pentylenetetrazole kindling epileptic rats show that the frequency and severity of epileptic attacks are remarkably suppressed after ablation of the epileptogenic focus. It is envisioned that this HPTT augmented CDT strategy may serve as a novel strategy for the treatment of focal epilepsy.

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Laser interstitial thermal therapy (LITT): Seizure outcomes for refractory mesial temporal lobe epilepsy

Cited by 66 publications

References 20 publications

Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients

Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients

Inverse national trends of laser interstitial thermal therapy and open surgical procedures for refractory epilepsy: a Nationwide Inpatient Sample–based propensity score matching analysis

Ferrous Disulfide‐Based Photothermal Nanocatalyst for NIR‐II Mild Hyperthermia‐Enhanced Chemodynamic Therapy of Temporal Lobe Epilepsy

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