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  • Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study

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Epilepsy
Original research
Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study
  1. Brett E Youngerman1,
  2. Matei A Banu1,
  3. Farhan Khan1,
  4. Guy M McKhann1,
  5. Catherine A Schevon2,
  6. Jonathan R Jagid3,
  7. Iahn Cajigas4,
  8. Christian B Theodotou3,
  9. Andrew Ko5,
  10. Robert Buckley5,
  11. Jeffrey G Ojemann5,
  12. John W Miller6,
  13. Adrian W Laxton7,
  14. Daniel E Couture7,
  15. Gautam S Popli8,
  16. Vivek P Buch9,
  17. Casey H Halpern4,
  18. Scheherazade Le10,
  19. Ashwini D Sharan11,
  20. Michael R Sperling12,
  21. Ashesh D Mehta13,
  22. Dario J Englot14,
  23. Joseph S Neimat15,
  24. Peter E Konrad14,
  25. Sameer A Sheth16,
  26. Elliot G Neal17,
  27. Fernando L Vale18,
  28. Kathryn L Holloway19,
  29. Ellen L Air20,
  30. Jason M Schwalb20,
  31. Pierre-François D’Haese21,
  32. Chengyuan Wu11
  1. 1 Department of Neurological Surgery, Columbia University, New York, New York, USA
  2. 2 Department of Neurology, Columbia University, New York, New York, USA
  3. 3 Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
  4. 4 Department of Neurological Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  5. 5 Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
  6. 6 Department of Neurology, University of Washington, Seattle, Washington, USA
  7. 7 Department of Neurological Surgery, Wake Forest University School of Medicine, Winston‐Salem, North Carolina, USA
  8. 8 Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  9. 9 Department of Neurological Surgery, Stanford Neuroscience Health Center, Stanford, California, USA
  10. 10 Department of Neurology, Stanford Comprehensive Epilepsy Center, Stanford, California, USA
  11. 11 Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  12. 12 Department of Neurology, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  13. 13 Department of Neurological Surgery, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
  14. 14 Department of Neurological Surgery, Vanderbilt University, Nashville, Nashville, Tennessee, USA
  15. 15 Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
  16. 16 Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
  17. 17 Department of Neurological Surgery, University of South Florida Health South Tampa Center, Tampa, Florida, USA
  18. 18 Department of Neurological Surgery, Medical College of Georgia-Augusta University, Augusta, Georgia, USA
  19. 19 Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
  20. 20 Department of Neurological Surgery, Henry Ford Health, Detroit, Michigan, USA
  21. 21 Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
  1. Correspondence to Dr Brett E Youngerman, Department of Neurological Surgery, Columbia University Medical Center, New York, NY 10032, USA; bey2103{at}cumc.columbia.edu

Abstract

Background Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown.

Methods This multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed.

Results Engel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year.

Conclusions MRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.

  • EPILEPSY, SURGERY
  • STEREOTAXIC SURGERY

Data availability statement

Data may be obtained from a third party and are not publicly available. Data may be requested from contributing sites with appropraite Institutional Review Board approval and data use agreements.

https://doi.org/10.1136/jnnp-2022-330979

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data may be requested from contributing sites with appropraite Institutional Review Board approval and data use agreements.

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    Footnotes

    • Twitter @jasonschwalbmd, @ChenWuMD

    • Contributors BEY, GMM, CAS, JJ, MS, DJE, P-FD and CW conceived the project. GMM, JJ, JO, JWM, AWL, DEC, VPB, CHH, AS, MS, ADM, JN, PK, SAS, FLV, EA and P-FD contributed to the design and implementation of the research. BEY, FK, CAS, IC, CBT, AK, RB, GSP, SL, ADM, DJE, EGN, KLH and JMS performed data collection and abstraction. BEY, MAB and FK performed data and statistical analysis. BEY took the lead in writing the manuscript and is responsible for the overall content as guarantor. All authors provided critical feedback and helped shape the research, analysis and manuscript.

    • Funding This work was supported by a Mentored Career Development Award (KL2TR001874) to BEY.

    • Competing interests Several centres that contributed data to this study are sites in the ongoing Stereotactic Laser Ablation for Temporal Lobe Epilepsy (SLATE) study (NCT02844465) sponsored by Medtronic (Minneapolis, Minnesota, USA). Procedures reported here precede any enrolment in SLATE. This study was not industry sponsored. AS is Chief Medical Officer of Medtronic Neuromodulation Operating Unit.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.