Surgical Outcomes of Laser Interstitial Thermal Therapy for Temporal Lobe Epilepsy: Systematic Review and Meta-analysis

Kerezoudis, Panagiotis; Parisi, Veronica; Marsh, W. Richard; Kaufman, Timothy J.; Lehman, Vance T.; Worrell, Gregory A.; Miller, Kai J.; Gompel, Jamie J. Van

doi:10.1016/j.wneu.2020.07.194

Cited by 44 publications

(35 citation statements)

References 37 publications

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“…We believe that this increase in seizure freedom rate is probably due to increase in sample size and not necessarily due to any change in surgical or patient selection approach. Our reported rate of seizure freedom for patients with MTS is comparable to the 66% (95% CI = 58%–74%) reported by a recent meta‐analysis including 384 patients with MTS 36 …”

Section: Discussionsupporting

confidence: 85%

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Magnetic resonance‐guided laser interstitial thermal therapy: Correlations with seizure outcome

Kang¹,

Pickard

Bronder³

et al. 2021

Epilepsia

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This study was undertaken to identify clinical factors associated with seizure freedom after magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) in temporal lobe epilepsy patients with unilateral mesial temporal sclerosis (MTS). Methods: We identified 56 patients with magnetic resonance imaging-defined MTS who underwent MRgLiTT with at least 1 year of follow-up. Primary outcome was seizure freedom at 1 year. We examined the association of seizure freedom and the following clinical factors: age at surgery, gender, history of febrile seizures, history of focal to bilateral tonic-clonic seizures, duration of epilepsy at the time of surgery, frequency of interictal epileptiform discharges (IEDs), seizure frequency, and presence of bilateral IEDs.

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Section: Discussionsupporting

confidence: 85%

“…Our reported rate of seizure freedom for patients with MTS is comparable to the 66% (95% CI = 58%-74%) reported by a recent meta-analysis including 384 patients with MTS. 36…”

Section: Limitationsmentioning

confidence: 99%

Magnetic resonance‐guided laser interstitial thermal therapy: Correlations with seizure outcome

Kang¹,

Pickard

Bronder³

et al. 2021

Epilepsia

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Objective: Laser interstitial thermal therapy (LITT) is a minimally invasive surgery for mesial temporal lobe epilepsy (mTLE), but the effects of individual patient anatomy and location of ablation volumes affect seizure outcomes. The purpose of this study is to see if features of individual patient structural connectomes predict surgical outcomes after LITT for mTLE.Methods: This is a retrospective analysis of seizure outcomes of LITT for mTLE in 24 patients. We use preoperative diffusion tensor imaging (DTI) to simulate changes in structural connectivity after laser ablation. A two-step machinelearning algorithm is applied to predict seizure outcomes from the change in connectomic features after surgery.Results: Although node-based network features such as clustering coefficient and betweenness centrality have some predictive value, changes in connection strength between mesial temporal regions predict seizure outcomes significantly better. Changes in connection strength between the entorhinal cortex (EC), and the insula, hippocampus, and amygdala, as well as between the temporal pole and hippocampus, predict Engel Class I outcomes with an accuracy of 88%. Analysis of the ablation location, as well as simulated, alternative ablations, reveals that a more medial, anterior, and inferior ablation volume is associated with a greater effect on these connections, and potentially on seizure outcomes.Significance: Our results indicate (1) that seizure outcomes can be retrospectively predicted with excellent accuracy using changes in structural connectivity, and (2) that favorable connectomic changes are associated with an ablation volume involving relatively mesial, anterior, and inferior locations. These results may provide a framework whereby individual pre-operative structural connectomes can be used to optimize ablation volumes and improve outcomes in LITT for mTLE.

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“…Seizure freedom rates following laser ablation in MTLE have been reported to approach that of temporal lobectomy, with seizure freedom rates reaching up to 69% at 12 months (17) and 54% at 26 months (13). However, meta-analysis recently demonstrated that after LiTT only 58% of patients with TLE and 66% of MTLE patients achieve seizure freedom (18). It is also generally accepted that patients with MTLE benefit from sEEG monitoring to confirm MT seizure onset, and that the presence of extra-temporal or bi-temporal onset predicts persistence of seizures following resection.…”

Section: Introductionmentioning

confidence: 99%

Ictal Onset Signatures Predict Favorable Outcomes of Laser Thermal Ablation for Mesial Temporal Lobe Epilepsy

et al. 2020

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Background: Laser interstitial thermal therapy (LiTT) has emerged as a minimally invasive option for surgical treatment of refractory epilepsy. However, LiTT of the mesial temporal (MT) structures is still inferior to anterior temporal lobectomy (ATL) in terms of postoperative outcome. In this pilot study, we identify intracranial EEG (iEEG) biomarkers that distinguish patients with favorable outcome from those with poor outcome after MT LiTT. Methods: We performed a retrospective review of 9 adult refractory epilepsy patients who underwent stereotactic electroencephalography (sEEG) followed by LiTT of MT structures. Their iEEG was retrospectively reviewed in both time and frequency domains. Results: In the time-domain, the presence of sustained 14-30 Hz in MT electrodes coupled with its absence from extra-MT electrodes at ictal onset was highly correlated with favorable outcomes, whereas the appearance of sustained 14-30 Hz or >30 Hz activity in extra-MT sites was negatively correlated to favorable outcomes. In the frequency domain, a declining spectral phase, beginning at the high frequency range (>14 Hz) at ictal onset and following a smooth progressive decline toward lower frequencies as the seizure further evolved, was positively correlated with improved outcomes. On the contrary, low frequency (<14 Hz) patterns and "crescendo-decrescendo" patterns with an early increasing frequency component at ictal onset that reaches the high-beta and low gamma bands before decreasing smoothly, were both correlated with poor surgical outcomes. Conclusions: This pilot study demonstrates the first evidence that iEEG analysis can provide neurophysiological markers for successful MT LiTT and therefore we strongly advocate for systematic sEEG investigations before offering MT LiTT to TLE and MTLE patients.

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Surgical Outcomes of Laser Interstitial Thermal Therapy for Temporal Lobe Epilepsy: Systematic Review and Meta-analysis

Cited by 44 publications

References 37 publications

Magnetic resonance‐guided laser interstitial thermal therapy: Correlations with seizure outcome

Magnetic resonance‐guided laser interstitial thermal therapy: Correlations with seizure outcome

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

Ictal Onset Signatures Predict Favorable Outcomes of Laser Thermal Ablation for Mesial Temporal Lobe Epilepsy

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