Authors :
Presenting Author: Aditi Trivedi, MD – University of California, San Diego
David Gonda, MD – Associate Clinical Professor, Department of Neurosurgery, University of California, San Diego; Maria Montenegro, MD/PhD – Clinical Professor, Department of Neurosciences, University of California, San Diego; Shifteh Sattar, MD – Clinical Professor, Department of Neurosciences, University of California, San Diego
Rationale: Laser interstitial thermal therapy (LITT) is an MRI-guided minimally invasive surgical technique for focal or multifocal epilepsies. Preliminary data suggests this method may be better tolerated with fewer surgical complications, and improved seizure freedom outcomes when compared to open resective options, though few large-scale studies in children have been described in the literature (Arocho-Quinones, 2023). Therefore, there is a need to understand the short term and long-term effects of laser ablation for intractable epilepsies in children to provide the best treatment. The aim of this study was to assess seizure outcome differences in patients who underwent LITT with lesional or non-lesional intractable epilepsies.
Methods: We performed a retrospective analysis of all patients with medically refractory epilepsy who underwent laser ablation between January 1, 2016 to March 1, 2023 at a level IV epilepsy center in a single tertiary care children’s hospital in the US. All patients with lesional or non-lesional focal intractable epilepsy receiving care at our pediatric hospital who received LITT to the presumed epileptogenic focus, and had at follow up data available were included. MRI data was used to determine lesional vs non lesional states. All patients had undergone comprehensive multidisciplinary presurgical epilepsy evaluations where a consensus decision had been achieved. All LITT procedures were performed using Visualease laser ablation systems by the neurosurgical team. Seizure free outcomes were measured according to the Engel surgical outcome scale.
Results: There were 41 patients with intractable epilepsy who underwent LITT for ablation of epileptogenic zones between January 1, 2016 and March 1, 2023. The median age was 17 years (mean of 16.28 years), and age ranged from two years to 26 years of age. Twelve patients (29%) had non-lesional epilepsy, and twenty-nine patients (71%) had lesional foci on MRI. Of the total patients, 25 (61%) were found to remain seizure free at one year follow up after laser ablation procedure. Of the non-lesional patients, n=5 (42%) achieved seizure freedom with Engel classification scores of 1, whereas of the lesional cases, n=20 (69%) achieved seizure freedom and Engel scores of 1 at one year post-operative follow ups (
Figure 1).
Conclusions: This study shows LITT improves seizure freedom rates in children with both lesional and non-lesional intractable epilepsy. Rates of seizure freedom after LITT were higher in lesional groups than those with non-lesional epilepsy. Further large-scale studies are needed to assess outcome differences in specific subsets including lesion location and epilepsy type in outcome differences with LITT. Additionally, neuropsychological, developmental outcomes, and understanding whether procedural modifications, such as number of catheters used, or location of ablation, affects seizure outcomes in the long term, should be studied.
Reference: Arocho-Quinones, E.V., et. al. (2023). Magnetic resonance imaging-guided stereotactic laser ablation therapy for the treatment of pediatric epilepsy: a retrospective multiinstitutional study.
J Neurosurg: Pediatrics, 31(6), 551-564. Funding: No funding sources were used for this study.