Laser ablation therapy: An alternative treatment for medically resistant mesial temporal lobe epilepsy after age 50.
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 1year postsurgery (mean follow-up: 1.0years (MRgLITT) vs. 1.8years (AMTL)). Mean LOS was shorter in the MRgLITT group (1.3days vs. 2.6days (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.
Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA. Electronic address: hwaseem@health.usf.edu.
Hena
H
Waseem
Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 East Fletcher Ave., Tampa, FL 33613, USA. Electronic address: keichsta@health.usf.edu.
Katie E
KE
Osborn
Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA; Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 East Fletcher Ave., Tampa, FL 33613, USA; Department of Neurology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 6th Floor, Tampa, FL 33606, USA. Electronic address: mschoenb@health.usf.edu.
Mike R
MR
Schoenberg
Department of Neurology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 6th Floor, Tampa, FL 33606, USA. Electronic address: vkelley@tgh.org.
Valerie
V
Kelley
Department of Neurology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 6th Floor, Tampa, FL 33606, USA; UCB BioSciences, Inc., 8010 Arco Corporate Drive, Raleigh, NC 27617, USA. Electronic address: abozorg@health.usf.edu.
Ali
A
Bozorg
Department of Neurology, Morton Plant Mease Hospital, 300 Pinellas Street, Clearwater, FL 33756, USA. Electronic address: drdanielcabello@gmail.com.
Daniel
D
Cabello
Department of Neurology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 6th Floor, Tampa, FL 33606, USA. Electronic address: sbenbadi@health.usf.edu.
Selim R
SR
Benbadis
Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, FL 33606, USA. Electronic address: fvale@health.usf.edu.
Fernando L
FL
Vale
D000367:Age Factors; D000368:Aged; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis* / Q000628:therapy*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome
Epilepsy surgery; Laser ablation; Magnetic resonance-guided laser interstitial thermal therapy; Medically resistant epilepsy; Temporal lobe epilepsy