Abstracts

Rationale: intractable epilepsy needs referral to Epilepsy Centers as after failure of greater than 2 medications surgical options may yield best results. Patients may fear standard methods of open craniotomy. An alternative methodology may be available in Surgical Laser.Thermoablation (SLA). We propose an alternative for some patients who would not be standard candidates or refused open craniotomy. Methods: We present 6 patients over age 18 (ages 19-56; 2male,4female),with refractive partial complex and secondary generalized seizure arising from a temporal lobe focus. There were 2 mesial temporal sclerosis cases of left temporal region, and 4 lateral temporal onset cases (2 left,2 right) with foci in left sub-Wernickes region, left anterior lateral temporal middle gurus, right middle temporal gyrus in 2 cases. All had no obvious tumor or heterotopia on 3tMRI. All patients had non-invasive pre-operative work-up with fMRI, Magnetoencephalogram, and neuropsychological testing. All chose SLA as surgical option when presented choices.Results: All patients had seizure freedom(4)or dramatic improvement.(6 seizure per day -1 /month, 6 seizures per day to 1 suspected seizure in 6 months post-SLA. One patient is off medications and seizure free, normal EEG. Range of seizure freedom and improvement is 6months to 1.75 years. Conclusions: SLA seems an alternative even in mesial temporal sclerosis cases and efficacy for Engle class 1-2 outcomes seems to be trend so far. More time and experience should confirm this surgical options which offers rapid recovery (usually <24 hours to discharge post-surgery). Patients and physicians may be more likely to consider this less invasive alternative which still allows standard surgical option if it fails in most cases.