Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: A multi-centre cohort study

Brett E. Youngerman; Matei A. Banu; Farhan Khan; Guy M. McKhann; Catherine A. Schevon; Jonathan R. Jagid; Iahn Cajigas; Christian B. Theodotou; Andrew Ko; Robert Buckley; Jeffrey G. Ojemann; John W. Miller; Adrian W. Laxton; Daniel E. Couture; Gautam S. Popli; Vivek P. Buch; Casey H. Halpern; Scheherazade Le; Ashwini D. Sharan; Michael R. Sperling; Ashesh D. Mehta; Dario J. Englot; Joseph S. Neimat; Peter E. Konrad; Sameer A. Sheth; Elliot G. Neal; Fernando L. Vale; Kathryn L. Holloway; Ellen L. Air; Jason M. Schwalb; Pierre François D'Haese; Chengyuan Wu

doi:10.1136/jnnp-2022-330979

Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: A multi-centre cohort study

Brett E. Youngerman, Matei A. Banu, Farhan Khan, Guy M. McKhann, Catherine A. Schevon, Jonathan R. Jagid, Iahn Cajigas, Christian B. Theodotou, Andrew Ko, Robert Buckley, Jeffrey G. Ojemann, John W. Miller, Adrian W. Laxton, Daniel E. Couture, Gautam S. Popli, Vivek P. Buch, Casey H. Halpern, Scheherazade Le, Ashwini D. Sharan, Michael R. SperlingAshesh D. Mehta, Dario J. Englot, Joseph S. Neimat, Peter E. Konrad, Sameer A. Sheth, Elliot G. Neal, Fernando L. Vale, Kathryn L. Holloway, Ellen L. Air, Jason M. Schwalb, Pierre François D'Haese, Chengyuan Wu

Neurosurgery

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Background Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown. Methods This multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed. Results Engel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year. Conclusions MRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.

Original language	English (US)
Pages (from-to)	879-886
Number of pages	8
Journal	Journal of Neurology, Neurosurgery and Psychiatry
Volume	94
Issue number	11
DOIs	https://doi.org/10.1136/jnnp-2022-330979
State	Published - Nov 1 2023

Keywords

EPILEPSY
STEREOTAXIC SURGERY
SURGERY

ASJC Scopus subject areas

Surgery
Clinical Neurology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/jnnp-2022-330979

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Youngerman, B. E., Banu, M. A., Khan, F., McKhann, G. M., Schevon, C. A., Jagid, J. R., Cajigas, I., Theodotou, C. B., Ko, A., Buckley, R., Ojemann, J. G., Miller, J. W., Laxton, A. W., Couture, D. E., Popli, G. S., Buch, V. P., Halpern, C. H., Le, S., Sharan, A. D., ... Wu, C. (2023). Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: A multi-centre cohort study. Journal of Neurology, Neurosurgery and Psychiatry, 94(11), 879-886. https://doi.org/10.1136/jnnp-2022-330979

Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: A multi-centre cohort study. / Youngerman, Brett E.; Banu, Matei A.; Khan, Farhan et al.
In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 94, No. 11, 01.11.2023, p. 879-886.

Research output: Contribution to journal › Article › peer-review

Youngerman, BE, Banu, MA, Khan, F, McKhann, GM, Schevon, CA, Jagid, JR, Cajigas, I, Theodotou, CB, Ko, A, Buckley, R, Ojemann, JG, Miller, JW, Laxton, AW, Couture, DE, Popli, GS, Buch, VP, Halpern, CH, Le, S, Sharan, AD, Sperling, MR, Mehta, AD, Englot, DJ, Neimat, JS, Konrad, PE, Sheth, SA, Neal, EG, Vale, FL, Holloway, KL, Air, EL, Schwalb, JM, D'Haese, PF & Wu, C 2023, 'Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: A multi-centre cohort study', Journal of Neurology, Neurosurgery and Psychiatry, vol. 94, no. 11, pp. 879-886. https://doi.org/10.1136/jnnp-2022-330979

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title = "Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: A multi-centre cohort study",

abstract = "Background Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown. Methods This multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed. Results Engel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year. Conclusions MRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.",

keywords = "EPILEPSY, STEREOTAXIC SURGERY, SURGERY",

author = "Youngerman, {Brett E.} and Banu, {Matei A.} and Farhan Khan and McKhann, {Guy M.} and Schevon, {Catherine A.} and Jagid, {Jonathan R.} and Iahn Cajigas and Theodotou, {Christian B.} and Andrew Ko and Robert Buckley and Ojemann, {Jeffrey G.} and Miller, {John W.} and Laxton, {Adrian W.} and Couture, {Daniel E.} and Popli, {Gautam S.} and Buch, {Vivek P.} and Halpern, {Casey H.} and Scheherazade Le and Sharan, {Ashwini D.} and Sperling, {Michael R.} and Mehta, {Ashesh D.} and Englot, {Dario J.} and Neimat, {Joseph S.} and Konrad, {Peter E.} and Sheth, {Sameer A.} and Neal, {Elliot G.} and Vale, {Fernando L.} and Holloway, {Kathryn L.} and Air, {Ellen L.} and Schwalb, {Jason M.} and D'Haese, {Pierre Fran{\c c}ois} and Chengyuan Wu",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

month = nov,

day = "1",

doi = "10.1136/jnnp-2022-330979",

language = "English (US)",

volume = "94",

pages = "879--886",

journal = "Journal of Neurology, Neurosurgery and Psychiatry",

issn = "0022-3050",

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number = "11",

}

TY - JOUR

T1 - Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence

T2 - A multi-centre cohort study

AU - Youngerman, Brett E.

AU - Banu, Matei A.

AU - Khan, Farhan

AU - McKhann, Guy M.

AU - Schevon, Catherine A.

AU - Jagid, Jonathan R.

AU - Cajigas, Iahn

AU - Theodotou, Christian B.

AU - Ko, Andrew

AU - Buckley, Robert

AU - Ojemann, Jeffrey G.

AU - Miller, John W.

AU - Laxton, Adrian W.

AU - Couture, Daniel E.

AU - Popli, Gautam S.

AU - Buch, Vivek P.

AU - Halpern, Casey H.

AU - Le, Scheherazade

AU - Sharan, Ashwini D.

AU - Sperling, Michael R.

AU - Mehta, Ashesh D.

AU - Englot, Dario J.

AU - Neimat, Joseph S.

AU - Konrad, Peter E.

AU - Sheth, Sameer A.

AU - Neal, Elliot G.

AU - Vale, Fernando L.

AU - Holloway, Kathryn L.

AU - Air, Ellen L.

AU - Schwalb, Jason M.

AU - D'Haese, Pierre François

AU - Wu, Chengyuan

PY - 2023/11/1

Y1 - 2023/11/1

N2 - Background Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown. Methods This multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed. Results Engel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year. Conclusions MRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.

AB - Background Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown. Methods This multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed. Results Engel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year. Conclusions MRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.

KW - EPILEPSY

KW - STEREOTAXIC SURGERY

KW - SURGERY

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SP - 879

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JO - Journal of Neurology, Neurosurgery and Psychiatry

JF - Journal of Neurology, Neurosurgery and Psychiatry

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ER -

Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: A multi-centre cohort study

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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