Long-Term Seizure and Psychiatric Outcomes Following Laser Ablation of Mesial Temporal Structures
Abstract number :
3.313
Submission category :
9. Surgery / 9A. Adult
Year :
2021
Submission ID :
1826643
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:55 AM
Authors :
Andres Kanner, MD, FAES, FAAN, FANA - University of Miami, Miller School of Medicine; Le Treice Irving - University of Miami, Miller School of Medicine; Iahn Cajigas - Neurosurgery - University of Miami, Miller School of Medicine; Anita Saporta - Neurology - University of Miami, Miller School of Medicine; Joacir Graciolli Cordeiro - Neurosurgery - University of Miami, Miller School of Medicine; Ramses Ribot - Neurology - University of Miami, Miller School of Medicine; Kamil Detyniecki - Neurology - University of Miami, Miller School of Medicine; Naymee Velez-Ruiz - Neurology - University of Miami, Miller School of Medicine; Manuel Melo-Bicchi - Neurology - University of Miami, Miller School of Medicine; Gustavo Rey - Neurology - University of Miami, Miller School of Medicine; Maru Palomeque - University of Miami, Miller School of Medicine; Tricia King-Aponte - Neurology - University of Miami, Miller School of Medicine; Christian Theodotou - Neurosurgery - University of Miami, Miller School of Medicine; Michael Ivan - Neurosurgery - University of Miami, Miller School of Medicine; Jonathan Jagid - Neurosurgery - University of Miami, Miller School of Medicine
Rationale: Reports of post-surgical seizure outcome following Laser interstitial thermal therapy (LITT) for the management of drug-resistant mesial temporal lobe epilepsy (MTLE) have been limited to two years. Furthermore, its impact on presurgical mood and anxiety disorders has not been investigated. The objectives of this study were: 1) to determine whether the post-ablation seizure outcome changes over time between 18 months and 6 years; 2) to investigate the seizure-free rate in the last follow-up year; 3) to identify the variables predictive of seizure-freedom; 4) to identify the impact of LiTT on pre-surgical mood and anxiety disorders.
Methods: Medical records of all patients who underwent LITT for MTLE from 2013 to 2020 at the UM Comprehensive Epilepsy Center were retrospectively reviewed. Demographic, epilepsy, cognitive, psychiatric and LiTT-related data were compared between seizure-free (Engel Class I) and non-seizure-free (Engel Class II+III+IV) patients. Statistical analyses included univariate and multivariate stepwise logistic regression analyses.
Results: 48 patients were included in the study; their mean age was 43±14.2 years old (range 21 to 78 years old). Post LiTT mean follow-up time was 49.9±20.7 months (range 18 – 81). Twenty-nine patients (60.5%) were free of disabling seizures, while 11 (22.9%) had less than 4 seizures / year. The seizure-free rate was 75% among patients with up to 35 months of follow-up and decreased to 61.5% among those with a 36 to 59 months follow-up period and to 44.5% among those with a ≥ 60 months follow-up period. However, 83% of all patients were seizure-free in the last follow-up year, independently of the follow-up period. Predictors of seizure-freedom included having mesial temporal sclerosis, no focal to bilateral tonic-clonic seizures and no psychopathology in the last follow-up year. Pre-surgical mood and /or anxiety disorder were identified in 30 patients (62.5%) and remitted in 19 (62%) of these patients after LiTT.
Conclusions: LITT appears to be a safe and effective surgical option for treatment-resistant MTLE, particularly among patients with MTS and no history of focal to bilateral tonic-clonic seizures. The seizure-freedom rate appears to follow a comparable course to that of antero-temporal lobectomies. Remission of presurgical mood and anxiety disorders can also result from LiTT.
Funding: Please list any funding that was received in support of this abstract.: None.
Surgery