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Laser Interstitial Thermal Therapy for the Treatment of Mesial Temporal Lobe Epilepsy in Children
Aditi M Trivedi1,2, Maria A Montenegro1,2, David Gonda1,2
1Department of Neurosciences, University of California, San Diego, CA, USA.
Insights
Laser interstitial thermal therapy (LITT) is a safe and effective epilepsy surgery for children with drug-resistant mesial temporal lobe epilepsy. Outcomes are more favorable in patients with hippocampal atrophy compared to those with nonlesional epilepsy.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Epileptology
Background:
- Limited research exists on laser interstitial thermal therapy (LITT) for pediatric epilepsy surgery.
- Mesial temporal lobe epilepsy (MTLE) is a common cause of drug-resistant epilepsy in children.
Purpose of the Study:
- To evaluate seizure-free outcomes in pediatric patients with MTLE undergoing LITT.
- To compare outcomes between lesional and nonlesional MTLE in this population.
Main Methods:
- Retrospective cohort study at a level 4 epilepsy center.
- Included 19 pediatric patients with MTLE undergoing LITT.
- Outcomes assessed using the Engel surgical outcome scale; MRI used to classify lesional vs. nonlesional epilepsy.
Main Results:
- Overall, 73.5% of patients achieved Engel 1 seizure freedom.
- Patients with hippocampal sclerosis (lesional group) had a 90% seizure-free rate.
- Patients with normal MRI (nonlesional group) had a 55.5% seizure-free rate.
- Younger age of seizure onset predicted better outcomes.
Conclusions:
- LITT is a safe and effective surgical option for drug-resistant pediatric MTLE.
- Favorable seizure-free outcomes are more likely in pediatric patients with hippocampal atrophy (lesional MTLE) than in those with nonlesional MTLE.
Abstract:
ObjectiveFew studies have explored the efficacy of laser interstitial thermal therapy in pediatric epilepsy surgery. This study aims to evaluate seizure-free outcomes in children and adolescents with mesial temporal lobe epilepsy who underwent laser interstitial thermal therapy.MethodsThis was a retrospective cohort study performed at a level 4 epilepsy center. All patients had comprehensive presurgical epilepsy evaluations with a consensus treatment decision made by a multidisciplinary team. Brain magnetic resonance imaging (MRI) data were used to determine lesional vs nonlesional groups. All laser interstitial thermal therapy procedures were performed using Visualase laser ablation systems by the neurosurgical team. Seizure-free outcomes were measured according to the Engel surgical outcome scale.ResultsThis study included 19 patients (12 girls, 7 boys). Age of epilepsy onset ranged from 2 to 17 years (mean 9.9 years), and age at time of surgery ranged from 8 to 20 years (mean 15.1 years). Ten patients (52.5%) had signs of hippocampal sclerosis on MRI (lesional group), and 9 patients (47.5%) had a normal brain MRI (nonlesional group). Engel 1 score was achieved by 14 of 19 patients (73.5%): 9 of 10 patients (90%) in the lesional group and 5 of 9 patients (55.5%) in the nonlesional group. Younger age of seizure onset was a predictor of better postsurgical outcome, but no other outcome predictors could be established.ConclusionLaser interstitial thermal therapy is safe and effective for the treatment of drug-resistant mesial temporal lobe epilepsy in children, rendering more favorable seizure-free outcomes in pediatric patients with hippocampal atrophy than in those with nonlesional mesial temporal lobe epilepsy.
