Seizure Outcome of MRI-Guided Laser Interstitial Thermal Therapy Compared to Resective Epilepsy Surgery: A Propensity Matched Cohort Study
Abstract number :
3.321
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1826024
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Omar Yossofzai, BSc - The Hospital for Sick Children; Scellig Stone – Boston Children’s Hospital; Joseph Madsen – Boston Children’s Hospital; Shelly Wang – Nicklaus Children’s Hospital; John Ragheb – Nicklaus Children’s Hospital; Ismail Mohamed – University of Alabama; Robert Bollo – University of Utah; Dave Clarke – Dell Children’s Medical Center; Scott Perry – Cook Children’s Medical Center; Alexander Weil – CHU Ste. Justine; Jeffrey Raskin – Indiana University; Jonathan Pindrik – Nationwide Children’s Hospital; Raheel Ahmed – University of Wisconsin; Sandi Lam – Lurie Children’s Hospital; Aria Fallah – University of California Los Angeles; Cassia Maniquis – University of California Los Angeles; Andrea Andrade – Schulich School of Medicine and Dentistry; George Ibrahim – The Hospital for Sick Children; University of Toronto; James Drake – The Hospital for Sick Children; University of Toronto; James Rutka – The Hospital for Sick Children; University of Toronto; Nicholas Mitsakakis – University of Toronto; Elysa Widjaja – The Hospital for Sick Children; University of Toronto
Rationale: MRI-guided laser interstitial thermal therapy (MRgLITT) is a novel minimally invasive treatment for drug resistant epilepsy (DRE). Although MRgLITT is a promising therapy, the effectiveness of MRgLITT remains uncertain. The aim of this study was to assess seizure outcome of MRgLITT compared to resective epilepsy surgery in children with DRE.
Methods: This North American multicenter retrospective cohort study recruited children treated with MRgLITT from 12 epilepsy surgery centers. Children treated with resective surgery from 4 epilepsy surgery centers form the comparator. Inclusion criteria were children under 18 years of age with focal DRE treated with MRgLITT or resective surgery with follow-up of at least one year. Exclusion criteria included corpus callosotomy, hemispherotomy, and prior resective surgery. Propensity scores were generated using baseline variables: age, sex, age at seizure onset, number of antiseizure medications, seizure frequency, seizure type, MRI findings, and ablation or surgery site. Patients in the two treatment groups were matched using 1:1 matching. To estimate treatment effects, we examined the odds ratio (OR) of seizure-free outcome after MRgLITT compared to resective surgery. Seizure outcome was assessed using the International League Against Epilepsy (ILAE) classification (ILAE class 1 = seizure free; ILAE class 2-6 = not seizure free). Complications were also evaluated.
Results: There were 170 MRgLITT and 435 resective surgery patients who met inclusion criteria. Following propensity score matching, 159 (93.5%) MRgLITT patients were matched to 159 resective surgery patients. Standardized differences of all the covariates were less than 0.1 indicating satisfactory matching. In the matched cohort, mean age at MRgLITT was 11.4 years (SD=5.1) and resective surgery was 11.5 years (SD=5.0). MRI findings in MRgLITT and resective surgery patients were cortical malformation in 36 (22.6%) vs. 35 (22%); tumor in 19 (11.9%) vs. 19 (11.9%); hippocampal sclerosis in 27 (17%) vs. 24 (15.1%); others in 77 (48.4%) vs. 81 (50.9%) respectively. Seizure-freedom was achieved in 80 (50.3%) MRgLITT patients and 94 (59.1%) resective surgery patients (OR=0.73, p=0.17). Complications were lower in MRgLITT compared to resective surgery, including infection (0.6% vs. 5% respectively, p=0.04), hemorrhage (0% vs 5.7% respectively, p< 0.01), and neurological deficits (5% vs. 25.2% respectively for both transient and permanent deficits, p< 0.01). Permanent hemiparesis, aphasia and sensory deficit were observed in 1 (0.6%), 1 (0.6%), and 0 patients respectively after MRgLITT, and in 12 (7.5%), 0, and 1 (0.6%) patients respectively after resective surgery.
Surgery