Abstracts

Rationale:
Temporal lobe epilepsy (TLE) is the most common type of drug resistant epilepsy. The standard anterior temporal lobe resection can bring the highest chance of seizure freedom. However, only limited percentage of patient affected actually meet the criteria of single focus TLE. The recent application of Laser interstitial thermal therapy (LITT) has brought new management philosophy. The general outcome approach has been raised to consider surgical option for patients with bilateral TLE. Mesial temporal epilepsy refers to the subgroup of epilepsy with most or all seizures staring from mesial temporal lobe, hippocampus and amygdala. LITT targeting greater amygdala volume is more likely to be associated with Engel I outcomes for bilateral mesial temporal lobe epilepsy.
Method:
Surgeries were performed with MRI guided LITT or standard ATL with intraoperative monitoring confirming residual margin without significant interictal epileptiform discharges. Six cases of LITT and four cases of surgical resection of temporal lobe were identified and compared. Consecutive adult patient list from neurosurgery was reviewed for the past three years. Elective surgeries on mesial temporal lobe epilepsy were selected for the study. The cases of tumor or vascular abnormalities were excluded. Four cases of case control statistical study were performed with SPSS. Primary end point is the seizure frequency of complex partial seizures and generalized convulsions at one month and one year at clinic visit. All cases were discussed in epilepsy conferences.
Results:
In majority of the cases, the seizure frequency of LITT patients decreased from daily complex partial seizures to once per month or even once per year. The seizure reduction rate was more than 80% in all subjects. Among the six patients, near seizure-free (Engel 1B) was achieved except for two cases of apparent bilateral temporal lobe epilepsy (Engel 1C and Engel 2). There is no statistical significance between the two surgically treated group on the outcomes of patients with temporal lobe epilepsy. These two groups had apparent better outcomes in seizure frequency. Family satisfaction rate was also better in the surgically treated group.
Conclusion:
The satisfactory outcome in the LITT group is beyond expectation because this group has had relatively lower expectation on seizure control given their intractable epilepsy of multifocal nature. These six patients nearly achieved seizure free status except for the subject with VNS placement. Secondly, the length of hospital stay was significantly lower in the LITT group, which in turn reduces complication rates and healthcare cost. The reported hemorrhage rate was about 2% in the LITT group which is comparably less than the traditional surgical resection procedure. The functional outcome of both groups was better compared to patients’ state prior to surgery. Since most of these cases with LITT has achieved favorable outcome, an advocate on updating the current algorithm may be called for LITT procedure on selected patients with bilateral temporal lobe epilepsy prior to a trial of VNS placement.
Funding:
:internal funding from LSU-S department of Neurology