Outcomes of Laser Interstitial Thermal Therapy in Pediatric Refractory Epilepsy Associated with Tuberous Sclerosis Complex: Reduction in Anti-seizure Medications and Developmental Improvement
Abstract number :
3.33
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2204996
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Chelsey Ortman, MD – Texas Children's Hospital, Baylor College of Medicine; Rohini Coorg, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Anne Anderson, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Irfan Ali, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Dave Clarke, MBBS – Department of Neurology, Department of Pediatrics – Dell Medical School, University of Texas at Austin; Gloria Diaz-Medina, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Maureen Handoko, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Kimberly Houck, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Akshat Katyayan, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Deepankar Mohanty, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Audrey Nath, MD, PhD – Department of Neurosurgery – University of Texas Medical Branch; Michael Quach, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; James Riviello, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Elaine Seto, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Danielle Takacs, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Cristina Trandafir, MD – Division of Neurology and Developmental Neuroscience, Department of Pediatrics – Texas Children's Hospital, Baylor College of Medicine; Howard Weiner, MD – Division of Pediatric Neurosurgery, Department of Surgery – Texas Children's Hospital, Baylor College of Medicine; Daniel Curry, MD – Division of Pediatric Neurosurgery, Department of Surgery – Texas Children's Hospital, Baylor College of Medicine
Rationale: Approximately two-thirds of all children with tuberous sclerosis complex (TSC) are diagnosed with focal or multifocal epilepsy refractory to medical treatment. Laser interstitial thermal therapy (LITT) offers a less invasive treatment for intractable focal or multifocal epilepsy in patients with TSC, as compared to traditional resection methods. In patients with TSC, seizure freedom may not always be sustained following LITT. However, optimization of developmental outcomes and reduction of anti-seizure medications (ASMs) may be achieved. This study evaluates whether patients with TSC who undergo LITT achieve a reduction in ASMs and subjective developmental improvement, in addition to a decreased frequency of seizures.
Methods: A retrospective analysis of all patients with TSC and medically refractory epilepsy who underwent LITT between July 1, 2016, to January 1, 2022, at a single tertiary children’s hospital in the United States was performed. Treatment and plans for minimally invasive intracranial monitoring were decided based on presurgical epilepsy evaluation and broad consensus at an epilepsy surgery conference. All patients underwent stereotactic EEG (sEEG) with the use of a ROSA surgical robot. Visualase and Neuroblate Laser Ablation systems were utilized to ablate epileptic foci. Reduction in number of anti-seizure medications, developmental improvement as reported by the patient’s family, and Engel scale were evaluated.
Results: There were 54 patients with TSC who underwent LITT during the study period, with an average age of 6 years old, median age of 3.8 years old, and range of 11 months to 23 years old. Of all patients who underwent LITT, 34 patients had at least six months of follow-up data available (mean follow-up duration 397 days). Of the patients with at least six months of follow-up, 68% (n=23) experienced developmental improvement, and 44% (n=15) experienced a reduction in the number of anti-seizure medications. The average Engel scale of all patients with at least 6 months follow-up was 2.5, with 41% of patients achieving outcomes of Engel I (n=9) or Engel II (n=5).
Conclusions: LITT may allow for a significant number of patients with TSC to achieve developmental improvement and reduce the number of anti-seizure medications needed, with an opportunity for improved overall quality of life. Future studies may help evaluate if objective neuropsychological testing, typically obtained at least one year following surgical intervention, confirms the subjective developmental improvement reported in this study. Further exploration is also needed to determine if specific subsets of TSC patients are more likely to experience developmental improvement or reduction in number of anti-seizure medications, as well as expand the number of patients for whom long-term outcomes are known following laser ablation.
Funding: No internal or external funding was received for this study.
Surgery