Abstracts

Rationale: Less than 1% of candidates eligible for anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (MTLE) actually undergo this potentially curative procedure. Some patients opt for palliative and not typically curative procedures such as vagal nerve stimulation (VNS) or Responsive Neuro-Stimulation (RNS). We report our experiences with patients choosing stereotactic laser amygdalo-hippocampotomy (SLAH) after initially undergoing VNS or RNS. Methods: Forty-five adult patients with pharmacoresistant medial temporal lobe epilepsy were enrolled in a multi-center trial evaluating the efficacy and safety of SLAH of medial temporal lobe epileptogenic foci. Eleven patients had previously undergone either VNS (10) or RNS (1). All 11 were refractory to medical therapy and neurostimulation, and consented to undergo SLAH. Mesial temporal sclerosis was documented in 10 of 11 subjects. Primary endpoint was monthly seizure frequency at one-year. Results: Among the 11 subjects who underwent SLAH after VNS or RNS, 6 of 9 (56%) were seizure-free at 12-month follow-up.Two subjects had not reached the one-year postsurgery mark. Of the three subjects not seizure-free at 12-month follow-up, one had a >75% reduction in seizures (from 6 in 90 days to 5 in 315 days). Adverse events included subdural hematoma (1 subject, evacuated with good recovery), headaches (5 subjects, resolved with medications), visual disturbance (1 subject, resolved), numbness (1 subject, resolving completely), and cellulitis (1 patient).Post-operative median length of stay (LOS) was 1 day. Conclusions: This pilot study suggests that laser ablation of the medial temporal lobe can be a curative procedure in some MTLE patients who are not seizure-free with neurostimulation such as VNS or RNS.