Outcome after laser interstitial thermal therapy (LITT) in patients with drug-resistant epilepsy
Emily In1, Mohamed Elrefaey2, James Castellano3, Mark Richardson4, Anto Bagic3, Niravkumar Barot3
1University of Pittsburgh School of Medicine, 2SUNY Upstate Medical University, 3University of Pittsburgh Medical Center, 4Massachusetts General Hospital
Objective:
To investigate the outcome of seizure freedom among patients with DRE who underwent LITT for temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE) and identify factors contributing to seizure recurrence after LITT.
Background:

Surgical resections offer the highest chance for seizure freedom for patients with drug-resistant epilepsy (DRE); however, over the last few years, there has been increased interest in exploring more minimally invasive surgical techniques, such as laser interstitial thermal therapy (LITT).

Design/Methods:
This retrospective chart review included patients who underwent LITT from 2015-2021. We collected data on demographics, clinical history, presurgical testing, postoperative complications, and seizure freedom outcomes at various time points. We conducted t-tests and Fisher’s exact tests to compare the percentages of seizure freedom for each factor of interest and a linear regression to determine whether these factors are strong predictors of seizure recurrence.
Results:

19 out of 29 patients (65.5%) were seizure free one year after LITT and 13/29 (44%) were seizure free at the last visit (mean FU duration = 49.5 months). Seizure freedom was 50% (12/24) among the TLE group and 20% (1/5) among the ETLE group at the last visit (p=0.343). Five patients (17%) had acute post-operative complications, which were reversible. Two patients (7%) reported memory and comprehension impairments. Gender, family history of epilepsy, handedness, etiology, and epilepsy duration were not significantly associated with seizure recurrence. Six patients underwent a re-operation, with five anterior temporal lobectomies and one additional ablation. Three of the ATL patients were seizure free after the operation, but the additional ablation did not result in seizure freedom.

Conclusions:

LITT can potentially offer seizure freedom to carefully selected patients with DRE. Our study showed the TLE group had higher proportions of patients with seizure freedom in comparison to the ETLE group, but it was not statistically significant given the small sample size.

10.1212/WNL.0000000000201851