Abstracts

Rationale: 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, operative complications, and the occurrence of neurological deficits.


Methods: We conducted a comprehensive search across PubMed, EMBASE, and Web of Science in pursuit of articles published up to September 2023, adhering to PRISMA guidelines. Univariate and multivariable mixed-effects Cox Proportional-Hazards regressions modeled the independent predictors of time to seizure recurrence, clustered by the study identifiers. Among patients for whom at least 12 months of follow-up time was recorded, univariate and multivariable mixed-effect logistic regression analyses were conducted to examine the independent risk factors associated with seizure recurrence at last follow-up, operative complications, and post-operative neurological deficits, clustered by study identifiers.


Results: The analysis included 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 years (SD:4.6). Focal seizures were most common (87.7%). The median number of anti-seizure medications tried prior to surgery was 3. Lesional MRI was evident in 82.0% of cases. The most common epilepsy etiologies were hypothalamic hamartoma (25.9%), malformations of cortical development (23.2%), and tuberous sclerosis complex (10.4%). Prior epilepsy surgery was reported in 19.4% of these patients. The Visualase system was employed in 89.6% of cases. Robotic-assisted stereotaxy was used to insert the laser chatheter in 53.7% of cases. Post-operative length of stay 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 seizure recurrence was associated with age at MRgLITT (p=0.043, 95% CI:1.00-1.15). Post-operative neurologic deficit was associated with lesional MRI findings (p=0.041, 95% CI:0.07-0.94). No factors were predictive of operative complications. See details in Table 1 and 2.


Conclusions: MRgLITT yields Engel-1 outcomes in a majority of patients. Only age at MRgLITT was statistically significant predictor for seizure recurrence despite the broad age range and diverse epilepsy etiologies in this review. Patients with a lesion on MRI had a lower risk of post-operative neurologic deficits. Further prospective studies should aim to clarify MRgLITT strategies in pediatric DRE.


Funding: None