Sudden Unexpected Death in Epilepsy After Laser Interstitial Thermal Therapy
Abstract number :
2.276
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2204881
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Behnaz Esmaeili, MD – University of Washington; Shahin Hakimian, MD – University of Washington; Andrew Ko, MD – University of Washington; Jason Hauptman, MD, PhD – University of Washington; Jeffrey Ojemann, MD, PhD – University of Washington; John Miller, Md, PhD – University of Washington; Steven Tobochnik, MD – Brigham and Women's Hospital
Rationale: To describe the characteristics of post-operative sudden unexpected death in epilepsy (SUDEP) after laser interstitial thermal therapy (LITT) for drug-resistant epilepsy.
Methods: This was a prospective observational study of consecutive patients treated with LITT at a single epilepsy center between 2013 and 2021 by three functional neurosurgeons. The primary outcome was the occurrence of SUDEP during post-operative follow-up. SUDEP was classified based on the Nashef definition. Surgical outcome was classified according to the Engel scale.
Results: There were 139 patients treated with LITT, including 137 (99%) in which ablation targeted mesial temporal structures. SUDEP occurred in 4/139 (2.9%; 95% CI, 1.09-7.5%) patients during a median follow-up of 36 (1.2-103.2) months, resulting in an estimated incidence of 8.6 (95% CI, 4.4-16.7) per 1000 person-years. All patients with SUDEP had a single seizure onset zone on pre-operative evaluation. Most deaths due to SUDEP (75%) occurred in patients with Engel class IV outcomes, although 1 (25%) patient carried an Engel class I outcome at the time of death. The median time to SUDEP after LITT was 39.6 (range, 3.9-84.7) months.
Conclusions: SUDEP was observed as both an early and late outcome after LITT, including in one patient who was previously seizure free. The incidence rate of SUDEP in this series was comparable to rates reported in non-surgical patients with drug-resistant epilepsy. Three of four deaths occurred during the evaluation period for additional resective surgery. Overall, these findings reinforce the goal of targeting seizure freedom to decrease the risk of SUDEP, including early consideration for repeat surgical intervention in patients with poor outcomes after an initial operation. Additional controlled studies are required to compare SUDEP risk between LITT and resective surgery.
Funding: None
Surgery