Abstracts

Rationale: Patients with medically resistant temporal lobe epilepsy are presented with multiple options to attain seizure freedom. Anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH) are two surgical options. Other minimally invasive treatments include gamma knife radiosurgery (GKRS) and more recently MR-guided laser interstitial thermal therapy (MRgLITT). The method of intervention can affect seizure outcome. The goal of this study is to review and compare the multiple options and the documented seizure free outcomes. Methods: A literature review was conducted to identify seizure outcomes for patients with medically intractable temporal lobe epilepsy who received ATL, SAH, GKRS, and MRgLITT. Results: Two major meta-analyses compared ATL and SAH. (Hu et al. J Neurosurg 2013;119:1089-1097) (Josephson et al. Neurology 2013;80:1669-1676) Both found ATL to be superior to SAH for seizure freedom, (71% vs. 66%) and one noted an increased chance of seizure freedom in patients with hippocampal sclerosis undergoing ATL vs. SAH. (Josephson et al. Neurology 2013;80:1669-1676) Presence of MTS is a common selection criteria for targeted interventions. Two large studies on GKRS found seizure freedom rates to range from 65-67% (follow up range 24 months-112 months). (Regis et al. Epilepsia 2004;45:504-515) (Rheims et al. Epilepsy Res 2008;80:23-29) The presence of MTS did not appear to impact outcomes in this small study population. Three studies of MRgLITT yielded a seizure freedom rate of 53%, with a higher rate in patients with mesial temporal sclerosis (MTS) (60.7%). (Kang et al. Epilepsia 2016;57:325-334) (Waseem et al. Epilepsy Beh 2015;51:152-157) (Willie et al. Neurosurgery 2014;74:569-584; discussion 584-565) Conclusions: In patients that do not respond to medical management, surgical intervention remains the most effective means of providing long-term seizure free outcomes. Minimally invasive techniques may provide comparable outcomes, but require more specific patient selection, including evaluation of MTS, and adverse effects must be weighed against the benefit of seizure freedom. Funding: None