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

Kang, Joon Y.; Pickard, Allyson; Bronder, Jay; Yenokyan, Gayane; Chen, Mo; Anderson, William S.; Sperling, Michael R.; Nei, Maromi

doi:10.1111/epi.16872

Cited by 8 publications

(4 citation statements)

References 34 publications

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“…In our study, these two variables were associated with a Class I outcome on univariate (but not multivariate) analyses. Of note, Kang et al 31 also found that older age at the time of surgery was associated with a Class I outcome after an LiTT.…”

Section: Discussionmentioning

confidence: 96%

Long‐term seizure and psychiatric outcomes following laser ablation of mesial temporal structures

et al. 2022

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Objective: Postsurgical seizure outcome following laser interstitial thermal therapy (LiTT) for the management of drug-resistant mesial temporal lobe epilepsy (MTLE) has been limited to 2 years. Furthermore, its impact on presurgical mood and anxiety disorders has not been investigated. The objectives of this study were (1) to identify seizure outcome changes over a period ranging from 18 to 81 months; (2) to investigate the seizure-free rate in the last follow-up year; (3) to identify the variables associated with seizure freedom; and (4) to identify the impact of LiTT on presurgical mood and anxiety disorders. Methods: Medical records of all patients who underwent LiTT for MTLE from 2013 to 2019 at the University of Miami Comprehensive Epilepsy Center were retrospectively reviewed. Demographic, epilepsy-related, cognitive, psychiatric, and LiTT-related data were compared between seizure-free (Engel Class I) and non-seizure-free (Engel Class II + III + IV) patients. Statistical analyses included univariate and multivariate stepwise logistic regression analyses.Results: Forty-eight patients (mean age = 43 ± 14.2 years, range = 21-78) were followed for a mean period of 50 ± 20.7 months (range = 18-81); 29 (60.4%) achieved an Engel Class I outcome, whereas 11 (22.9%) had one to three seizures/ year. Seizure-freedom rate decreased from 77.8% to 50% among patients with 24and >61-month follow-up periods, respectively. In the last follow-up year, 83% of all patients were seizure-free. Seizure freedom was associated with having mesial temporal sclerosis (MTS), no presurgical focal to bilateral tonic-clonic seizures, and no psychopathology in the last follow-up year. Presurgical mood and/or anxiety disorder were identified in 30 patients (62.5%) and remitted after LiTT in 19 (62%).Significance: LiTT appears to be a safe and effective surgical option for treatmentresistant MTLE, particularly among patients with MTS. Remission of presurgical mood and anxiety disorders can also result from LiTT.

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Section: Discussionmentioning

confidence: 96%

Long‐term seizure and psychiatric outcomes following laser ablation of mesial temporal structures

et al. 2022

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“…However, previous studies have suggested how the presence of selected electrographic characteristics may be associated with seizure outcome. For example, the presence of preoperative bilateral temporal interictal discharges, 56 tonic–clonic seizures, 57 and interictal temporal delta slowing 58 have been shown to be predictive of seizure outcomes. Only a limited number of patients had documentation of this electrographic information available, and therefore were not included in our analysis as a covariate.…”

Section: Discussionmentioning

confidence: 99%

Ablation of apparent diffusion coefficient hyperintensity clusters in mesial temporal lobe epilepsy improves seizure outcomes after laser interstitial thermal therapy

et al. 2023

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Objective Laser interstitial thermal therapy (LiTT) is a minimally invasive surgical procedure for intractable mesial temporal epilepsy (mTLE). LiTT is safe and effective, but seizure outcomes are highly variable due to patient variability, suboptimal targeting, and incomplete ablation of the epileptogenic zone. Apparent diffusion coefficient (ADC) is a magnetic resonance imaging (MRI) sequence that can identify potential epileptogenic foci in the mesial temporal lobe to improve ablation and seizure outcomes. The objective of this study was to investigate whether ablation of tissue clusters with high ADC values in the mesial temporal structures is associated with seizure outcome in mTLE after LiTT. Methods Twenty‐seven patients with mTLE who underwent LiTT at our institution were analyzed. One‐year seizure outcome was categorized as complete seizure freedom (International League Against Epilepsy [ILAE] Class I) and residual seizures (ILAE Class II–VI). Volumes of hippocampus and amygdala were segmented from the preoperative T1 MRI sequence. Spatially distinct hyperintensity clusters were identified in the preoperative ADC map. Proportion of cluster volume and number ablated were associated with seizure outcomes. Results The mean age at surgery was 37.5 years and the mean follow‐up duration was 1.9 years. Proportions of hippocampal cluster volume (p = .013) and number (p = .03) ablated were significantly higher in patients with seizure freedom. For amygdala clusters, the proportion of cluster number ablated was significantly associated with seizure outcome (p = .026). In the combined amygdalohippocampal complex, ablation of amygdalohippocampal clusters reliably predicted seizure outcome by their volume ablated (area under the curve [AUC] = 0.7670, p = .02). Significance Seizure outcome after LiTT in patients with mTLE was associated significantly with the extent of cluster ablation in the amygdalohippocampal complex. The results suggest that preoperative ADC analysis may help identify high‐yield pathological tissue clusters that represent epileptogenic foci. ADC‐based cluster analysis can potentially assist ablation targeting and improve seizure outcome after LiTT in mTLE.

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“…Moreover, there is a vast literature on postoperative outcome reports, showing that seizure freedom is only achieved in 60–65% of patients in whom mesiotemporal epilepsy surgery is performed [e.g., 6 , 7 ], including selective approaches like LITT [ 2 ], clearly showing that there is a need to improve patient selection for selective mesiotemporal interventions and to differentiate this group from seizure origin in other brain regions with similar electroclinical features. It is a misunderstanding of our publication that 100% of patients with mesiotemporal seizure origin when operated become seizure free—this gold standard of postoperative seizure freedom for correct localization of the epileptogenic zone was an inclusion criterion for the comparator group with mTLE rather than an outcome report.…”

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confidence: 99%

How to identify insular epilepsy

Schulze‐Bonhage

Lizana

2022

J Neurol

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

Cited by 8 publications

References 34 publications

Long‐term seizure and psychiatric outcomes following laser ablation of mesial temporal structures

Long‐term seizure and psychiatric outcomes following laser ablation of mesial temporal structures

Ablation of apparent diffusion coefficient hyperintensity clusters in mesial temporal lobe epilepsy improves seizure outcomes after laser interstitial thermal therapy

How to identify insular epilepsy

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