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

被引：30

作者：

Youngerman, Brett E. ^{[1
,22
]}

Banu, Matei A. ^{[1
]}

Khan, Farhan ^{[1
]}

McKhann, Guy M. ^{[1
]}

Schevon, Catherine A. ^{[2
]}

Jagid, Jonathan R. ^{[3
]}

Cajigas, Iahn ^{[4
]}

Theodotou, Christian B. ^{[3
]}

Ko, Andrew ^{[5
]}

Buckley, Robert ^{[5
]}

Ojemann, Jeffrey G. ^{[5
]}

Miller, John W. ^{[6
]}

Laxton, Adrian W. ^{[7
]}

Couture, Daniel E. ^{[7
]}

Popli, Gautam S. ^{[8
]}

Buch, Vivek P. ^{[9
]}

Halpern, Casey H. ^{[4
]}

Le, Scheherazade ^{[10
]}

Sharan, Ashwini D. ^{[11
]}

Sperling, Michael R. ^{[12
]}

Mehta, Ashesh D. ^{[13
]}

Englot, Dario J. ^{[14
]}

Neimat, Joseph S. ^{[15
]}

Konrad, Peter E. ^{[14
]}

Sheth, Sameer A. ^{[16
]}

Neal, Elliot G. ^{[17
]}

Vale, Fernando L. ^{[18
]}

Holloway, Kathryn L. ^{[19
]}

Air, Ellen L. ^{[20
]}

Schwalb, Jason M. ^{[20
]}

D'Haese, Pierre-Francois ^{[21
]}

Wu, Chengyuan

机构：

[1] Columbia Univ, Dept Neurol Surg, New York, NY USA

[2] Columbia Univ, Dept Neurol, New York, NY USA

[3] Univ Miami, Jackson Mem Hosp, Dept Neurol Surg, Miami, FL USA

[4] Univ Penn, Dept Neurol Surg, Perelman Sch Med, Philadelphia, PA USA

[5] Univ Washington, Dept Neurol Surg, Seattle, WA USA

[6] Univ Washington, Dept Neurol, Seattle, WA USA

[7] Wake Forest Univ, Dept Neurol Surg, Sch Med, Winston Salem, NC USA

[8] Wake Forest Univ, Dept Neurol, Sch Med, Winston Salem, NC USA

[9] Stanford Neurosci Hlth Ctr, Dept Neurol Surg, Stanford, CA USA

[10] Stanford Comprehens Epilepsy Ctr, Dept Neurol, Stanford, CA USA

[11] Thomas Jefferson Univ, Vickie & Jack Farber Inst Neurosci, Dept Neurol Surg, Philadelphia, PA USA

[12] Thomas Jefferson Univ, Vickie & Jack Farber Inst Neurosci, Dept Neurol, Philadelphia, PA USA

[13] Zucker Sch Med Hofstra Northwell, Dept Neurol Surg, Hempstead, NY USA

[14] Vanderbilt Univ, Dept Neurol Surg, Nashville, TN USA

[15] Univ Louisville, Dept Neurol Surg, Louisville, KY USA

[16] Baylor Coll Med, Dept Neurol Surg, Houston, TX USA

[17] Univ S Florida, Dept Neurol Surg, Hlth South Tampa Ctr, Tampa, FL USA

[18] Augusta Univ, Med Coll Georgia, Dept Neurol Surg, Augusta, GA USA

[19] Virginia Commonwealth Univ, Dept Neurol Surg, Richmond, VA USA

[20] Henry Ford Hlth, Dept Neurol Surg, Detroit, MI USA

[21] West Virginia Univ, Rockefeller Neurosci Inst, Morgantown, WV USA

[22] Columbia Univ, Med Ctr, Dept Neurol Surg, New York, NY 10032 USA

来源：

JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY | 2023年 / 94卷 / 11期

关键词：

EPILEPSY; SURGERY; STEREOTAXIC SURGERY; GAMMA-KNIFE RADIOSURGERY; LOBE EPILEPSY; COGNITIVE OUTCOMES; LOBECTOMY; ABLATION; ASSOCIATION; SCLEROSIS; NEUROLOGY; PATTERNS; SOCIETY;

D O I：

10.1136/jnnp-2022-330979

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BackgroundMagnetic 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. MethodsThis 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. ResultsEngel 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 & GE;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 & GE;1 year. ConclusionsMRgLITT 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.

引用

页码：879 / 886

页数：8

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