Predictors of outcome after MRgLiTT for the treatment of mesial temporal sclerosis
Abstract number :
368
Submission category :
9. Surgery / 9A. Adult
Year :
2020
Submission ID :
2422713
Source :
www.aesnet.org
Presentation date :
12/6/2020 12:00:00 PM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Mo Chen, Johns Hopkins Hospital; Joon Kang - Johns Hopkins University; Allyson Pickard - Thomas Jefferson University Hospital; Maromi Nei - Thomas Jefferson University Hospital; Michael Sperling - Thomas Jefferson University Hospital;;
Rationale:
Magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) is increasingly becoming the preferred surgical treatment method for patients with temporal lobe epilepsy (TLE) with unilateral hippocampal sclerosis (HS). The predictors for seizure freedom after MRgLiTT of TLE-HS are unknown. We aimed to identify prognostic factors which predict outcome at 1 year after MRgLiTT of TLE-HS.
Method:
We identified 56 patients who had undergone pre-surgical evaluation including video-EEG and had brain magnetic resonance imaging (MRI) demonstrating HS who had undergone MRgLiTT with at least 1 year of follow-up. The primary outcome was seizure freedom (Engel I) at one year. In order to determine predictors of outcome, we conducted multivariate analysis including the following variables: sex, duration of epilepsy, seizure frequency, generalized tonic-clonic seizures (GTC) within 1 year, presence of inter-ictal epileptiform discharge (IEDs), frequency of IEDs, presence of IEDs contralateral to HS and presence of periodic lateralized epileptiform discharges (PLEDs).
Results:
Of 56 patients who underwent MRgLiTT, 35 (62.5%) of patients were seizure free at 1 year. Among the surgical outcome predictors, the presence of generalized tonic-clonic seizures within 1 year (odds ratio [OR] 0.258, 95% CI (0.055-0.986) was associated with poor surgical outcome at 1 year after MRgLiTT.
Conclusion:
Approximately a third of patients with HS experience recurrence seizures within 1 year after MRgLiTT. Our findings suggest that seizure recurrence is most likely due to involvement of a broader epileptogenic network extending beyond HS.
Funding:
:None
Surgery