Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Nov;94(11):879-886.
doi: 10.1136/jnnp-2022-330979. Epub 2023 Jun 19.

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

Brett E Youngerman  1 , Matei A Banu  2 , Farhan Khan  2 , Guy M McKhann  2 , Catherine A Schevon  3 , Jonathan R Jagid  4 , Iahn Cajigas  5 , Christian B Theodotou  4 , Andrew Ko  6 , Robert Buckley  6 , Jeffrey G Ojemann  6 , John W Miller  7 , Adrian W Laxton  8 , Daniel E Couture  8 , Gautam S Popli  9 , Vivek P Buch  10 , Casey H Halpern  5 , Scheherazade Le  11 , Ashwini D Sharan  12 , Michael R Sperling  13 , Ashesh D Mehta  14 , Dario J Englot  15 , Joseph S Neimat  16 , Peter E Konrad  15 , Sameer A Sheth  17 , Elliot G Neal  18 , Fernando L Vale  19 , Kathryn L Holloway  20 , Ellen L Air  21 , Jason M Schwalb  21 , Pierre-François D'Haese  22 , Chengyuan Wu  12
Affiliations
Multicenter Study

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

Brett E Youngerman et al. J Neurol Neurosurg Psychiatry. 2023 Nov.

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.

Keywords: EPILEPSY, SURGERY; STEREOTAXIC SURGERY.

PubMed Disclaimer

Conflict of interest statement

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.

Figures

Figure 1.
Figure 1.. Seizure outcomes after laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) (n=268).
After initial LITT, Engel I outcome was achieved in 65.9% (170/258) at 6 months, 55.8% (149/267) a 1 year, 52.5% (126/240) at 2 years, and 49.3% (132/268) at last follow-up ≥1 year (median 47 months, range 12–95 months). Engel I or II outcomes were achieved in 76.0% (196/258) at 6 months, 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years, and 66.0% (177/268) at last follow-up. At last follow-up, 8.6% (23/268) had undergone anterior temporal lobectomy and 3.3% (9/268) had a repeat LITT with no further surgery. At last follow-up after all surgeries, 57.1% (153/268) were Engel I and 75.4% (177/268) were Engel I or II. Patients with some disabling seizures after surgery but free of disabling seizures for at least 2 years were classified as Engel I at last follow-up. Patients with more than rare disabling seizures after surgery bur rare seizures for at least 2 years were classified as Engel II at last follow-up.
Figure 2.
Figure 2.. Survival curve for loss of Engel I and Engel II outcome after LITT for mTLE.
The blue curve represents the proportion of patients with surviving Engel I outcome (cumulative survival) over time. The green curve represents patients with Engel I or II outcome (ie. failure is loss of at least Engel II status). Hash marks represent patients censored due to end of follow-up. Note, patients with disabling seizures after the first postoperative week “fail” Engel I status on the survival curve and patients with more than rare disabling seizures “fail” Engel II status even if these outcomes are ultimately achieved with improvement at last follow-up. Engel I and II rates are therefore lower on the survival curves than at last follow-up after primary MRgLITT (Figure 1) because outcomes improved after initial seizure recurrence in some patients but treatment failure does not recover on the survival curve.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

References

    1. Semah F, Picot MC, Adam C, Broglin D, Arzimanoglou A, Bazin B, et al. Is the underlying cause of epilepsy a major prognostic factor for recurrence? Neurology. 1998. Nov 1;51(5):1256–62. - PubMed
    1. Wiebe S, Blume WT, Girvin JP, Eliasziw M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001. Aug 2;345(5):311–8. - PubMed
    1. Engel J, McDermott MP, Wiebe S, Langfitt JT, Stern JM, Dewar S, et al. Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA. 2012. Mar;307(9):922–30. - PMC - PubMed
    1. Josephson CB, Dykeman J, Fiest KM, Liu X, Sadler RM, Jette N, et al. Systematic review and meta-analysis of standard vs selective temporal lobe epilepsy surgery. Neurology. 2013. Apr;80(18):1669–76. - PubMed
    1. Ostendorf AP, Ahrens SM, Lado FA, Arnold ST, Bai S, Owen MKB, et al. United States Epilepsy Center Characteristics: A Data Analysis From the National Association of Epilepsy Centers. Neurology. 2022. Feb 1;98(5):e449–58. - PMC - PubMed

Publication types