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

Abstract

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.

Optimized SEEG-guided radiofrequency thermocoagulation for mesial temporal lobe epilepsy with hippocampal sclerosis

“…But LiTT has become increasingly used by many centers as an alternative to open surgery in certain patients of drug-resistant epilepsy. The latest Meta-analysis of 16 studies that included 269 patients with drug-resistant epilepsy has showed the safety and efficacy of MRI-guided LiTT in the treatment of drug-resistant MTLE, TLE and insular epilepsy [8].…”

“…It can eliminate a second procedure and minimize the risk that a second electrode placement might not be at the precise site of recorded epileptiform activity. Furthermore, SEEG-guided RF-TC is relatively more manageable while LiTT has a learning curve of clinical utilization and the related complications and treatment failure have been reported [8,37]. Additionally, SEEG are relatively more widespread while LiTT is not universally available.…”

“…For patients with MTLE-HS, in recent years, magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (LiTT) [6][7][8][9][10][11][12][13][14][15] has emerged as a promising minimally invasive alternative to classical open resection. But this new surgical technique is not universally available and the indications, safety and efficacy need further evaluation.…”

Effects of laser interstitial thermal therapy for mesial temporal lobe epilepsy on the structural connectome and its relationship to seizure freedom

“…2,3 Major neurological complications in epilepsy surgery are rare, 4 but neuropsychological sequelae are more commonly reported, particularly after dominant hemisphere resection. 5,6 Laser interstitial thermal therapy (LITT) is a minimally invasive surgery for mTLE, with two recent metaanalyses 7,8 reporting seizure-freedom rates comparable to ATL in cases involving mesial temporal sclerosis. 9 LITT results in a shorter hospital stay, increased likelihood of being discharged home, and lower hospitalization charges, 10 and there is evidence that neurocognitive outcomes after LITT are superior to that after ATL.…”

Surgical Treatments of Epilepsy

“…73 Currently, LITT is being used by an increasing number of centers for epilepsy, as trials are actively being completed and favorable outcomes are presented. 74,75 Indications Indications for LITT are similar to resective surgery for focal epilepsy. Ideal candidates have evidence of a unilateral mesial temporal focus without neocortical temporal lobe involvement, 69,[76][77][78] hypothalamic hamartomas, 79 complex and deep focal cortical dysplasias, 80 tuberous sclerosis, 81 and subependymal giant cell astrocytomas.…”