Skip to main content
2024 AANS Annual Scientific Meeting Main banner
Back

Stereotactic/ Functional Rapid Fire Abstract

Stereotactic and Functional

Laser Interstitial Thermal Therapy for Mesial Temporal Lobe Epilepsy: Long-term Outcomes Beyond 5 Years

Saturday, May 4, 2024
3:33 PM – 3:35 PM CT
Location:  S405b
Disclosure(s):
Alexander C. Horn, BA: No financial relationships to disclose
Introduction: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a minimally invasive treatment for mesial temporal lobe epilepsy (MTLE) and as an alternative to anterior temporal lobectomy (ATL). However, the long-term seizure freedom durability of MRgLITT has yet to be reported, especially beyond 5 years.

Methods: This was a cohort study of patients with MTLE who underwent MRgLITT at Wake Forest University School of Medicine between 2012 and 2023. Patients with less than 5 years of follow-up were excluded. Demographics, baseline characteristics, and post-operative outcome data were collected from a prospectively maintained database. Engel classification was used to determine post-operative seizure outcome.

Results: Forty patients had MRgLITT for MTLE with at least 5 years of follow-up. Mean follow-up length was 8 years (97 months) with a range of 5.1-11.1 years. Thirty-one (77.5%) were Engel class I at last follow-up, 5 (13%) Engel class II, 3 (7.5%) were Engel class III, and 1 (3%) was Engel class IV. Seven (17.5%) patients were antiseizure medication (ASM) free at last follow-up. Twenty-three (57.5%) patients had ipsilateral mesial temporal sclerosis (MTS), and 35 (87.5%) had ipsilateral positron emission tomography (PET) hypometabolism.

Conclusion : This study reports the longest outcomes of MRgLITT for MTLE by far, demonstrating excellent seizure freedom rates at last follow-up from 5 to 11 years. Furthermore, the response and durability of MRgLITT is comparable to historical reports of ATL. While some patients were able to taper off all ASMs, most remained on medications. A striking feature of this series is patient selection with the vast majority of these patients having ipsilateral MTS and/or ipsilateral PET hypometabolism. We believe careful patient selection is a key factor contributing to the success of MRgLITT in this patient cohort. MRgLITT is a durable treatment option for long-term management of drug resistant MTLE.