Abstracts

Rationale: MRI-Guided Stereotactic Laser Tissue Ablation Surgery (MSLTA) is becoming more commonly used as an option for intractable epilepsy. Outcomes in adults have shown improvement or less loss of function than traditional surgeries, especially in anterior temporal lobe cases vs standard lobectomy. We present available pre-and post-neuropsychological testing observations in eight pediatric patients who underwent MSLTA at our institution. Due to our clinical pediatric population, our cases include temporal, frontal, and occipital lobe MSLTA, and not just temporal lobe MSLTA Methods: Eight patients, 8-17 years of age (3 female, 5 male), with mesial temporal dominant (2), mesial temporal non-dominant (1), lateral temporal (1), left frontal (2), right frontal (1), and right occipital (1) foci, had comparison of pre-and post-MSLTA neuropsychological testing. Differing age and baseline functioning as well as different localization in cortex made direct comparison limited. Reliable change indices were calculated to determine functional decline, stability, or improvement from pre- to post-surgery. Results: Two dominant mesial temporal 17 year olds showed improvement in executive global functioning and emotional/behavioral regulation, improved attention and processing speed, and stable or improved full scale IQ, with one showing some verbal decline but stable verbal IQ and visual skills. A non-dominant temporal case showed stable results in all categories above. The left frontal case showed stable IQ scores in all domains, mild decline in expressive vocabulary, and improved emotional and adaptive skills. The right frontal cases showed stability or mild IQ decline, stable verbal, emotional and attention scores, and improved emotional and adaptive skills. The occipital case was lower functioning at baseline, but IQ, verbal, and visual skills remained stable, while emotional and adaptive skills improved.   Conclusions: These pediatric MSLTA cases demonstrate less severe or stable language, stable or improved IQ scores, or improvement in various emotional, behavioral and executive global functioning after surgery compared to baseline. Dominant temporal cases had more risk of language decline, but not global behavioral or IQ changes post-surgery. Improvement in over half of our patients or stability in most testing domains support the safety and potential benefit from MSLTA procedures in intractable pediatric epilepsy. However, more clinical data from multiple centers is needed to support this conclusion and further understand long-term neuropsychological outcomes of this type of epilepsy surgery.  Funding: None