Magnetic Resonance Imaging-guided Laser Ablation Therapy for Pediatric Drug-resistant Epilepsy: A Systematic Review and Individual Participant Data Meta-analysis
Alexander Kuruvilla1, Manish Shetty2, Sean Woods2, Sukru Aras3, Cemal Karakas4
1Department of Child Neurology, University of Louisville, 2University of Louisville, 3CHOP, 4Norton Children's Hospital, University of Louisville
Objective:

Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) is emerging as a minimally invasive alternative to open resective surgery for pediatric drug-resistant epilepsy (DRE). This systematic review and individual participant data meta-analysis aimed to identify independent predictors of seizure outcomes post-MRgLITT.

Background:
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Design/Methods:

A comprehensive literature search was conducted adhering to PRISMA guidelines. Multivariable mixed-effects logistic regression was employed to analyze the predictors of seizure recurrence.

 

Results:

The analysis encompassed 382 pediatric patients (Male:57.9%) with a mean epilepsy duration of 7.5 years (SD: 5.3). The average age at MRgLITT was 4.3 year (SD:4.6). Focal seizures were predominant (87.7%). The median number of anti-seizure medications tried was 3. Lesional MRI was evident in 82.0% of cases. The major epilepsy etiologies included hypothalamic hamartoma (25.9%), malformations of cortical development (23.2%), and tuberous sclerosis complex (10.4%). Prior epilepsy surgery was reported in 19.4%. The Visualase system was employed in 89.6% of cases. Robotic-assisted stereotaxy was the most used stereotactic technique (53.7%). Post-operation, the mean length of hospitalization was ≤2 days for 65.7% of patients. Seizure recurrence was noted in 46.5% of cases, with a mean time to recurrence of 8.2 months (SD: 6.3). Engel-1 outcomes were achieved in 57.6% of patients. During the mean follow-up of 15.8 months (SD: 11.3), 7.6% underwent revision epilepsy surgery. The detailed examination of descriptive data yielded a thorough profile of the study population yet failed to highlight any statistically significant patterns correlating with seizure recurrence.

Conclusions:

The high rate of favorable Engel-1 outcomes underscores MRgLITT's potential in pediatric DRE management. However, despite the broad age range and diverse epilepsy etiologies, no statistically significant predictors for seizure recurrence were identified. Further robust, prospective studies are warranted to elucidate potential predictors and optimize MRgLITT therapeutic strategy in pediatric DRE.

10.1212/WNL.0000000000208266