Authors :
Presenting Author: Jessica Falco-Walter, MD – Stanford University
David Hartmann, MD, PhD – Stanford University
Gavin Touponse, BS – Stanford University
Robert Fisher, MD, PhD – Stanford University
Kimford Meador, MD – Stanford University
Jaimie Henderson, MD – Stanford University
Gerald Grant, MD – Stanford University
Casey Halpern, MD – University of Pennsylvania
Vivek Buch, MD – Stanford University
Scheherazade Le, MD – Stanford University
Rationale:
LITT is a minimally invasive alternative to traditional open surgery with anterior temporal lobectomy (ATL) for focal drug-resistant epilepsy (DRE). Long-term durability is largely unknown. We describe long-term seizure outcomes and complications after LITT in our Stanford cohort with intractable MTLE.
Methods:
We prospectively and retrospectively tracked our refractory MTLE cases treated with LITT from October 2014 - October 2023. A minimum of 2 years of follow up after LITT was required to be included. Non-temporal LITT cases were excluded. Primary endpoints were (1) Engel surgery seizure outcomes after initial LITT and (2) reduction in seizure frequency. Secondary outcomes were (a) seizure outcomes after subsequent procedure and (b) post-ablation complications.
Results:
61 patients underwent selective amygdalohippocamptomy via LITT. Mesial temporal sclerosis was present in 42 (69%). Median follow-up was 6 yrs (range 2-10.5), median follow-up was 74 months (range 24-128). At last follow-up, Engel Class I outcome (free of disabling seizures) after initial LITT was 59% (n=36). Engel Class IA was achieved in 18% (n=11) with completely seizure-free; Engel Class IB in 13% (n=8) with non-disabling focal aware seizures only; Engel Class IC in 20% (n=12) with some disabling seizures but free of disabling seizures for at least 2 years; Engel ID in 8% (n=5) with generalized convulsions with anti-seizure medication withdrawal. Engel Class II was 20% (n=12) with rare disabling seizures; Engel Class III 18% (n=11) with worthwhile improvement; Engel Class IV 3% (n=2) no worthwhile improvement. The majority of subjects had reduction in baseline seizure frequency: 90% (n=55) had > 50% reduction and 70% (n=43) had > 90% reduction.
After initial ablation, complications included peri-operative seizures within 30 days in 31% (n=19) and non-seizure complaints in 25% (n=15). There was one permanent superior quadrantanopsia and 7% (n=4) had transient cranial nerve III and VI palsies.
There were 17 subjects (28%) who had suboptimal response after initial LITT and had a subsequent procedure: 14 (40%) had repeat ipsilateral LITT and 3 (5%) had anterior temporal lobectomies; no patients had neuromodulation. Average follow-up after subsequent procedure was 22 months. Engel Class I outcome after subsequent procedure was 47% (8/17). After subsequent LITT, there was one CN III palsy (7%).
Conclusions:
Our study reports on the longest seizure outcomes following LITT for treatment of intractable MTLE. Engel Class I outcome was achieved in 59% after initial LITT, and the majority had significant sustained reduction in baseline seizure frequency. After subsequent procedure, about half of patients had Engel Class I outcomes. Complications were largely temporary. LITT is a minimally invasive, well-tolerated, first-line option with durable outcomes and marked seizure reduction in carefully selected drug-resistant MTLE patients. Subsequent LITT, ATL remain viable options for subjects with persistent seizures after initial LITT.
Funding: None