TY - JOUR
T1 - Laser ablation therapy
T2 - An alternative treatment for medically resistant mesial temporal lobe epilepsy after age 50
AU - Waseem, Hena
AU - Osborn, Katie E.
AU - Schoenberg, Mike R.
AU - Kelley, Valerie
AU - Bozorg, Ali
AU - Cabello, Daniel
AU - Benbadis, Selim R.
AU - Vale, Fernando L.
N1 - Publisher Copyright:
© 2015 Elsevier Inc.
Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Selective anterior mesial temporal lobe (AMTL) resection is considered a safe and effective treatment for medically refractory mesial temporal lobe epilepsy (MTLE). However, as with any open surgical procedure, older patients (aged 50 +) face greater risks. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has shown recent potential as an alternative treatment for MTLE. As a less invasive procedure, MRgLITT could be particularly beneficial to older patients. To our knowledge, no study has evaluated the safety and efficacy of MRgLITT in this population.Seven consecutive patients (aged 50. +) undergoing MRgLITT for MTLE were followed prospectively to assess surgical time, complications, postoperative pain control, length of stay (LOS), operating room (OR) charges, total hospitalization charges, and seizure outcome. Five of these patients were assessed at the 1-year follow-up for seizure outcome. These data were compared with data taken from 7 consecutive patients (aged 50 +) undergoing AMTL resection.Both groups were of comparable age (mean: 60.7 (MRgLITT) vs. 53 (AMTL)). One AMTL resection patient had a complication of aseptic meningitis. One MRgLITT patient experienced an early postoperative seizure, and two MRgLITT patients had a partial visual field deficit. Seizure-freedom rates were comparable (80% (MRgLITT) and 100% (AMTL) (p. >. 0.05)) beyond 1. year postsurgery (mean follow-up: 1.0. years (MRgLITT) vs. 1.8. years (AMTL)). Mean LOS was shorter in the MRgLITT group (1.3. days vs. 2.6. days (p. <. 0.05)). Neuropsychological outcomes were comparable.Short-term follow-up suggests that MRgLITT is safe and provides outcomes comparable to AMTL resection in this population. It also decreases pain medication requirement and reduces LOS. Further studies are necessary to assess the long-term efficacy of the procedure.
AB - Selective anterior mesial temporal lobe (AMTL) resection is considered a safe and effective treatment for medically refractory mesial temporal lobe epilepsy (MTLE). However, as with any open surgical procedure, older patients (aged 50 +) face greater risks. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has shown recent potential as an alternative treatment for MTLE. As a less invasive procedure, MRgLITT could be particularly beneficial to older patients. To our knowledge, no study has evaluated the safety and efficacy of MRgLITT in this population.Seven consecutive patients (aged 50. +) undergoing MRgLITT for MTLE were followed prospectively to assess surgical time, complications, postoperative pain control, length of stay (LOS), operating room (OR) charges, total hospitalization charges, and seizure outcome. Five of these patients were assessed at the 1-year follow-up for seizure outcome. These data were compared with data taken from 7 consecutive patients (aged 50 +) undergoing AMTL resection.Both groups were of comparable age (mean: 60.7 (MRgLITT) vs. 53 (AMTL)). One AMTL resection patient had a complication of aseptic meningitis. One MRgLITT patient experienced an early postoperative seizure, and two MRgLITT patients had a partial visual field deficit. Seizure-freedom rates were comparable (80% (MRgLITT) and 100% (AMTL) (p. >. 0.05)) beyond 1. year postsurgery (mean follow-up: 1.0. years (MRgLITT) vs. 1.8. years (AMTL)). Mean LOS was shorter in the MRgLITT group (1.3. days vs. 2.6. days (p. <. 0.05)). Neuropsychological outcomes were comparable.Short-term follow-up suggests that MRgLITT is safe and provides outcomes comparable to AMTL resection in this population. It also decreases pain medication requirement and reduces LOS. Further studies are necessary to assess the long-term efficacy of the procedure.
KW - Epilepsy surgery
KW - Laser ablation
KW - Magnetic resonance-guided laser interstitial thermal therapy
KW - Medically resistant epilepsy
KW - Temporal lobe epilepsy
UR - http://www.scopus.com/inward/record.url?scp=84939483703&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84939483703&partnerID=8YFLogxK
U2 - 10.1016/j.yebeh.2015.07.022
DO - 10.1016/j.yebeh.2015.07.022
M3 - Article
C2 - 26280814
AN - SCOPUS:84939483703
SN - 1525-5050
VL - 51
SP - 152
EP - 157
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
ER -