Abstracts

Rationale: Cerebral cortical dysplasias are migration disorders with altered connectivity, excitatory/inhibitory imbalance, intractable epilepsy, motor and neurocognitive comorbidities, often necessitating epilepsy surgery. Conventional surgical techniques are associated with complications and morbidities. Hence, we investigated the acute, mid and long-term efficacy and safety of MRI-guided laser-induced thermal ablation technology, for treatment of seizures and neurocognitive comorbidities associated with cortical dysplasias. Methods: A 15-year-old boy with autism spectrum disorder, neurocognitive, difficulties, anxiety, obsessive-compulsive disorder and intractable epilepsy due to left temporal open-lip schizencephaly underwent video EEG monitoring that revealed partial seizures (confusion, photophobia) with left mid, posterior temporal, mid-posterior inferior temporal, parietal spikes with corroborative reduced left temporal FDG uptake on PET-CT. Hence, sequential laser-ablation of the schizencephalic cortex from ventricular to pial end was performed. Post-procedure MRI confirmed ablation and disconnection of the entire dysplastic cortex. A 16 year-old boy, with intractable complex partial epilepsy (tonic left arm/leg stiffening, rhythmic shaking, left greater than right eyelid fluttering) with right central, parietal spikes, underwent MRI that revealed right parietal cortical dysplasia with corraborative PET-CT. MRI-guided laser ablation of the dysplastic cortex was carried out with post-procedure MRI confirming complete ablation of the dysplastic cortex. A 9-year-old boy with complex partial epilepsy, electrical status epilepticus of sleep, neurocognitive/motor delays, in the setting of septo-optic dysplasia, bilateral temporal lobe schizencephaly, with seizures focally involving the left temporal head regions, and PET CT revealing diminished metabolic activity in the left anterior temporal lobe. MRI-guided laser ablation of the dysplastic cortex was carried out with post-procedure MRI confirming complete ablation of the dysplastic cortex. Results: The first patient, with 1-3 weekly preoperative seizures, had immediate seizure freedom, improvements in autism, anxiety, neurocognitive faculty. He has been seizure free 16 months post procedure despite discontinued lamotrigine and zonisamide. Despite an average of 30 daily seizures, motor difficulties and epileptic encephalopathy preoperatively, the second patient attained immediate post procedure seizure freedom. He is seizure free and ambulatory, 12 months post procedure. The third patient is seizure free immediately after a recent procedure despite daily seizures preoperatively. Conclusions: Favorable acute, mid/long term outcomes provide further evidence for safety and efficacy of MRI-guided thermal laser ablation as a promising novel technology that may revolutionize epilepsy surgery with elimination of perioperative risks encountered with conventional surgical techniques in cortical dysplasias.