Final Neuropsychological Outcomes Following Epilepsy Laser Interstitial Thermal Therapy: A Multicenter Cohort
Patrick Landazuri1, Jennifer Gess2, David Denney3, Bradley Folley4, Christian Lobue5, Melissa Sutcliffe6, Taylor Abel6, James Baumgartner7, Joseph Neimat8, Viktor Palys2, Caleb Pearson1
1University of Kansas Medical Center, 2University of Arkansas for Medical Sciences, 3Univeristy of Texas Southwestern Medical Center, 4Norton Neuroscience Institute, 5University of Texas Southwestern, 6University of Pittsburgh, 7Advent Health for Children, 8University of Louisville
Objective:
To assess post operative cognitive changes following epilepsy laser ablation
Background:
Laser interstitial thermal therapy (LITT) is a minimally invasive neurosurgical tool used to ablate epileptic foci, with positive evidence for post-operative seizure freedom and cognition. Still, post-operative LITT neuropsychological outcomes are less known. The LAANTERN (Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate system) Registry is a prospective multi-center study. A sub-study in epilepsy, PatiEnt Neuropsychological outcomeS After laseR ablation (PENSAR), captured cognitive outcomes for select LAANTERN sites.
Design/Methods:
Select pre- and post-operative neuropsychological test (NT) outcomes were obtained. Outcomes were stratified by epilepsy localization. Changes from pre- to post-operative NT were evaluated utilizing raw and demographically corrected T-scores. A post-operative change was defined as >1 standard deviation from pre-operative testing. Corrected scores were obtained using normative samples from the Calibrated Neuropsychological Normative System (CNNS, PAR Inc.)
Results:
Forty-seven patients (27 male) from seven centers completed the study. Mesial temporal lobe LITT (N=40) was the most common procedure. There were no significant post operative raw score changes. For corrected scores, verbal memory was stable for all post-LITT localizations. Processing speed and visual memory declines were seen post left-temporal LITT (35.7% and 25%, respectively) as well as right-temporal LITT (42.9% and 35.7%, respectively). Extra-temporal LITT patients were more likely to experience decline involving processing speed and executive functioning (66.7% and 50% respectively).
Conclusions:
Cognitive functioning was largely unchanged following LITT, notably including verbal memory. Non-significant declines were seen in processing speed and visual memory following temporal lobe LITT and executive functioning following extra-temporal LITT. Processing speed also was impacted post-LITT. These findings suggest LITT is a safe alternative in terms of cognitive functioning for those considering epilepsy surgery. Although the lack of post-LITT significant decline is promising, direct comparison to open resection would further elucidate relative cognitive risk following LITT.
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