title: Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy.
abstract: OBJECTIVE
  To describe mesial temporal lobe ablated volumes, verbal memory, and surgical outcomes in patients with medically intractable mesial temporal lobe epilepsy (mTLE) treated with magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LiTT).
  
  
  METHODS
  We prospectively tracked seizure outcome in 20 patients at Thomas Jefferson University Hospital with drug-resistant mTLE who underwent MRI-guided LiTT from December 2011 to December 2014. Surgical outcome was assessed at 6 months, 1 year, 2 years, and at the most recent visit. Volume-based analysis of ablated mesial temporal structures was conducted in 17 patients with mesial temporal sclerosis (MTS) and results were compared between the seizure-free and not seizure-free groups.
  
  
  RESULTS
  Following LiTT, proportions of patients who were free of seizures impairing consciousness (including those with auras only) are as follows: 8 of 15 patients (53%, 95% confidence interval [CI] 30.1-75.2%) after 6 months, 4 of 11 patients (36.4%, 95% CI 14.9-64.8%) after 1 year, 3 of 5 patients (60%, 95% CI 22.9-88.4%) at 2-year follow-up. Median follow-up was 13.4 months after LiTT (range 1.3 months to 3.2 years). Seizure outcome after LiTT suggests an all or none response. Four patients had anterior temporal lobectomy (ATL) after LiTT; three are seizure-free. There were no differences in total ablated volume of the amygdalohippocampus complex or individual volumes of hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, and fusiform gyrus between seizure-free and non-seizure-free patients. Contextual verbal memory performance was preserved after LiTT, although decline in noncontextual memory task scores were noted.
  
  
  CONCLUSIONS
  We conclude that MRI-guided stereotactic LiTT is a safe alternative to ATL in patients with medically intractable mTLE. Individualized assessment is warranted to determine whether the reduced odds of seizure freedom are worth the reduction in risk, discomfort, and recovery time. Larger prospective studies are needed to confirm our preliminary findings, and to define optimal ablation volume and ideal structures for ablation.
authors.affiliation: Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.|Department of Neurology, Johns Hopkins Epilepsy Center, Johns Hopkins University, Baltimore, Maryland, U.S.A.
authors.forename: Joon Y
authors.initials: JY
authors.lastname: Kang
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Chengyuan
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Joseph
authors.initials: J
authors.lastname: Tracy
authors.affiliation: Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.|Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lorenzo
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: James
authors.initials: J
authors.lastname: Evans
authors.affiliation: Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Maromi
authors.initials: M
authors.lastname: Nei
authors.affiliation: Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Christopher
authors.initials: C
authors.lastname: Skidmore
authors.affiliation: Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Scott
authors.initials: S
authors.lastname: Mintzer
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Sharan
authors.affiliation: Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Sperling
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000679:Amygdala / Q000473:pathology / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D000069279:Drug Resistant Epilepsy / Q000473:pathology / Q000601:surgery*; D018728:Entorhinal Cortex / Q000473:pathology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology / Q000601:surgery; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory; D008875:Middle Aged; D019635:Neurosurgical Procedures; D009929:Organ Size; D020534:Parahippocampal Gyrus / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D012640:Seizures; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Drug-resistant epilepsy; Laser ablation; Selective amygdalohippocampectomy; Temporal lobe epilepsy; Temporal lobectomy