Authors :
Presenting Author: Patrick Landazuri, MD – University of Kansas
Jennifer Cheng, MD, MS – University of Kansas Medical Center
Eric Leuthardt, MD – Washington University
Albert Kim, MD, PhD – Washington University
Peter Fecci, MD, PhD – Duke University Medical Center
Derek Southwell, MD, PhD – Duke University Medical Center
Joseph Neimat, MD, MS – University of Louisvile
David Sun, MD, PhD – Norton Neuroscience Institute, Norton Health Care
Bradley Lega, MD – University of Texas Southwestern Medical Center
Fedor Panov, MD – Mount Sinai Health System
Veronica Chiang, MD – Yale Univesrity
Taylor Abel, MD, FAES, FAANS – Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center
Sharona Ben-Haim, MD – University of California San Diego
David Piccioni, MD, PhD – University of California San Diego
Analiz Rodriguez, MD, PhD – University of Arkansas for Medical Sciences
Viktoras Palys, MD, FAANS, FCNS – University of Arkansas for Medical Sciences
S. Kathleen Bandt, MD – Indiana University Health
Joseph Petronio, MD – United Children's St. Paul
Michael Lacroix, MD – Geisinger Neuroscience Institute
James Baumgartner, MD – Florida Hospital Advent Health
Rationale: Laser interstitial thermal therapy (LITT) is a surgical tool used to ablate epileptic foci and brain tumors. In drug resistant epilepsy, LITT has been used most commonly for MTLE as an alternate consideration to anterior temporal lobectomy due to patient preference, lower post operative pain, and shorter hospital stays. The Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate system (LAANTERN) is a multicenter study (NCT02392078) designed to prospectively enroll patients undergoing LITT and follow patients for up to 5 years. Here we selectively analyze LAANTERN patients who underwent LITT for MTLE.
Methods: Patients undergoing LITT were consented for enrollment into the LAANTERN registry. Patients undergoing LITT for MTLE who were eligible for at least 6 months follow-up were included in this analysis. Demographics, epilepsy and seizure characteristics, procedural data, post-surgical seizure outcomes, and quality of life (QoL) scores were analyzed.
Results: Fifteen centers contributed 145 MTLE patients who underwent LITT, of whom 77 reached two-year follow up. Fourteen patients were considered pediatric (age < 22 at LITT). The average age was 39.2 years at time of surgery. The two most common etiologies were mesial temporal sclerosis (74) and unknown etiology/MRI normal (31). Average ablation volume was 5.2 ± 3.4 mL. The average length of surgery was 4.3 ± 2.1 hours (260.3 ± 125.4 minutes)
and average blood loss was 22mL. The median length of stay was 1.3 days and 33 patients (23%) had no ICU-time post-procedure. The average discharge head pain score was 2.1 on a 0-10 scale. Almost all patients (96.6%) were discharged home.
Seizure outcomes at two-year follow up were 58.5% and 57.2% for Engel 1 and ILAE1/2 outcomes, respectively. There was no change in seizure outcomes at different time points through the trial suggesting no hypothesized practice effect through the years. No clinical characteristic predicted positive or negative seizure outcome, although focal to bilateral tonic-clonic semiology trended towards being a negative predictor. Adverse events were seen in 13.8% of patients (20/145), the majority being mild or transient. Pediatric seizure outcomes were not different than adult outcomes. Just
over 1/3 of patients stopped or decreased their anti-seizure medicines (ASM) with seizure outcomes no different compared to patients without ASM changes.
Improvements in QoL comprising the overall QOLIE-31 score and majority of QOLIE-31 subdomains were seen at almost all time points assessed, with some racial and ethnic differences noted.
Conclusions: We report the largest prospective MTLE LITT cohort. These real-world data continue to demonstrate MTLE LITT is well tolerated with clinically relevant seizure and QoL improvements. As such, LITT can be considered a standard treatment option for surgical epilepsy.
Funding: Monteris Medical