Efficacy of MRI-Guided Laser Interstitial Thermal Therapy for Refractory Epilepsy: A Systematic Review and Meta-Analysis
Abstract number :
3.329
Submission category :
9. Surgery / 9C. All Ages
Year :
2021
Submission ID :
1826748
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Olga Kuhlenko, MD - University of Magdeburg, Dpt. of Neurology; Rostyslav Kukhleno - University of Magdeburg, Dpt. of Neurology; Arne Ilse - University of Magdeburg, Dpt. of Neurology; christiane Georg - University of Magdeburg, Dpt. of Neurology; Yana Terziyska - University of Magdeburg, Dpt. of Neurology; Lars Buentjen - University of Magdeburg, Dpt. of Setertactic Neurosurgeryogy; Aiken Haghikia - University of Magdeburg, Dpt. of Neurology; Hans-Jochen Heinze - University of Magdeburg, Dpt. of Neurology; Jürgen Voges - University of Magdeburg, Dpt. of Stereotactic Neurosurgery; Friedhelm Scmitt, MD - University of Magdeburg, Dpt. of Neurology
Rationale: To investigate the safety and efficacy of directed magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) in drug-refractory epilepsy (DRE) in adult and pediatric patients according to different epilepsy etiologies and / or syndromes.
Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, GoogleScolar and Cochrane Library were systematically searched for indexed publications in the English. 601 results in the time range from 1984 to December 2020. After the revision according to the selection criteria, 76 studies with 1021 patients were included in qualitative statistical analysis (figure).
Results: Mesial temporal lobe epilepsy (MTLE). The meta-analysis included 15 studies (total 358 patients), including patients with DRE MTLE with and without hippocampal sclerosis. The mean age of the patient was 39.1±14.3 years. The mean duration of the last follow up was 18.6 months; some reported clinical cases received up to 3 subsequent ablation procedures. Most studies (98%) used the Visualase © (Medtronic, USA) System. The seizure freedom rate at last follow up was 61, 09% (Engel class I, 95% CI, 56–66%). Engel class II outcome was achieved in 15.7% (95% CI, 11-20%). The permanent complication rate was 5.6% (95% CI, 2-9%), whereas the temporary complication rate was 10.1% (95% CI, 6-15%). The most common complication was visual field deficit (3%-9% in larger series), most were transient or non-disabling, and rates appear lower than with anterior temporal lobectomy.
Hypothalamic hamartoma (HH). In the meta-analysis, we included 7 studies (total cohort 170 patients). Seizure freedom for gelastic seizures was 73% (CI 57-87%, p=0.0013). There have been 2 reports of disabling amnestic syndromes due to bilateral mammillary body damage in patients with likely prior unilateral injury from anterior temporal lobectomy.
Focal cortical dysplasia (FCD). Our meta-analysis included 4 studies with a total of 51 patients with FCD. In the analysed group of patients, 65% reached Engel class I outcome (95% CI, 30-92%, p< 0.001). Two patients had procedural complications (intraventricular haemorrhage / aseptic meningitis), both without relevant residual neurological deficit.
Surgery