Introduction: Laser interstitial thermal therapy (LiTT) is changing the way we treat mesial temporal epilepsy (MTE). Because LiTT is minimally invasive and does not preclude further treatment, it is on its way to becoming a “first line” treatment for drug resistant MTE patients. However, because LiTT is relatively new, not much is known about associated complications and long-term seizure freedom rates.
Methods: The medical records of all patients that underwent LiTT for MTE from 2013 to 2017 at the University of Miami hospital under a single surgeon were retrospectively reviewed. Information related to epilepsy history, preoperative clinical evaluations, imaging, and outcomes were compared between seizure free (SF) and non-seizure-free (NSF) patients.
Results: 20 patients were identified with at least two years of follow up. Mean age was 41.8±13.4 years and 40% were female. After a mean follow-up time of 36.6 months (range 24.6 – 45.0 months), 65% (13/20) were free of disabling seizures and 20% (4/20) had only rare disabling seizures. Patients had an average epilepsy history of 26±12.9 years and underwent a total 4.6±1.05 ablations, and there was no significant difference in epilepsy history or ablation number between SF and NSF groups. While the presence of mesial temporal sclerosis (MTS) was similar between the SF and NSF groups (62.5% vs. 72.7%, p=.66), patients with any post-operative seizure without MTS had a shorter median time to first seizure compared to patients with MTS (1 month versus 13 months, log-rank test p=0.006). The post-operative complication rate was 10% consisting of one permanent and one transient homonymous hemianopia.
Conclusions: LiTT appears to be a safe and effective initial treatment option in the treatment of medication refractory MTE. Among patients that have seizures after treatment, those without MTS appear to have seizures earlier than those with MTS.
Patient Care: By understanding the factors that affect seizure freedom after LiTT, clinicians will be better able to determine which patient will benefit from treatment and better counsel those that have already undergone treatment.
Learning Objectives: Report the two-year outcomes and permanent neurological deficits in patients that have undergone laser interstitial thermal therapy for mesial temporal epilepsy.