Laser Interstitial Thermal Therapy for Drug Resistant Epilepsy at the University of Kansas Medical Center (KUMC)
Abstract number :
V.048
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2021
Submission ID :
1825799
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:50 AM
Authors :
Maryam Matloub, MBChB - University of Kansas Medical Center; Patrick Landazuri - Department of Neurology - University of Kansas Medical Center; Jennifer Cheng - Department of Neurosurgery - University of Kansas Medical Center; Carol Ulloa - Department of Neurology - University of Kansas Medical Center; Michael Kinsman - Department of Neurosurgery - University of Kansas Medical Center; Vishal Shah - Department of Neurology - University of Kansas Medical Center; Nancy Hammond - Department of Neurology - University of Kansas Medical Center; Paul Camarata - Department of Neurosurgery - University of Kansas Medical Center; Utku Uysal - Department of Neurology - University of Kansas Medical Center
Rationale: Epilepsy surgery is an effective treatment for patients with drug resistant epilepsy (DRE). Although open surgery is highly effective, efforts to improve the safety and neuropsychological profile of epilepsy surgery are continually sought. Laser interstitial thermal therapy (LITT) is a minimally invasive technique that is an alternative to open surgery for patients with defined epileptogenic foci. LITT can be an option for high-risk patients who may not tolerate open resection. Compared to open resection, LITT has shorter hospital stays and less postoperative pain with possible improved neuropsychological outcomes. We report our center’s LITT safety profile and outcomes.
Methods: The KUMC Epilepsy Surgery database was searched for patients who underwent LITT between 1-1-2013 to 1-1-2021. Patients with >12 months follow-up duration were included in final data analysis. Demographic, clinical, neuroimaging, and treatment information were collected. Engel seizure outcome classification score was utilized to assess seizure freedom. The primary outcome was seizure freedom. Descriptive analysis was performed. Variables were reported as mean or median for numerical variables and percentage for categorical variables.
Results: Forty-one patients underwent LITT during the study period. Only 36 patients were analyzed as five patients had less than one year follow up. 41.7% of the study patients were males. Mean age was 45.2 ± 14.6 years (range 25-84). Mean seizure onset age was 13.8 ±14.8. Focal epilepsy was noted in 97.2% of patients and 2.8% had generalized epilepsy. Mesial temporal sclerosis (MTS) was the most common epilepsy etiology (61%) followed by malformation of cortical development (16.7%).
After the first LITT, 44.4% patients were Engel 1 outcome. A second surgery (LITT or open resection) was pursued in 9 of 36 patients (25%). After second surgery, 44.4% were completely seizure free (Engel 1A). Taken together, 52% of patients achieved Engel 1 outcome. For patients who achieved complete seizure freedom (Engel 1A), the mean seizure freedom duration was 34.8 months ± 14.7. Mesial temporal sclerosis was the most common etiology (61%), of which 59.1% achieved Engel 1 outcome.
Post operatively, two patients had small asymptomatic intracranial hemorrhage, one patient had acute encephalopathy and one patient had a scalp infection. All other patients (88.8%) had no complications.
Conclusions: LITT is an effective treatment for DRE. Our center’s outcomes are comparable to reported literature. Our findings also suggest that LITT has low complication risk.
Funding: Please list any funding that was received in support of this abstract.: The author(s) received no specific funding for this work.
Clinical Epilepsy