Laser ablation therapy: An alternative treatment for medically resistant mesial temporal lobe epilepsy after age 50

Hena Waseem; Katie E Osborn; Mike R Schoenberg; Valerie Kelley; Ali Bozorg; Daniel Cabello; Selim R Benbadis; Fernando L Vale

doi:10.1016/j.yebeh.2015.07.022

Laser ablation therapy: An alternative treatment for medically resistant mesial temporal lobe epilepsy after age 50

Epilepsy Behav. 2015 Oct:51:152-7. doi: 10.1016/j.yebeh.2015.07.022. Epub 2015 Aug 13.

Authors

Hena Waseem¹, Katie E Osborn², Mike R Schoenberg³, Valerie Kelley⁴, Ali Bozorg⁵, Daniel Cabello⁶, Selim R Benbadis⁷, Fernando L Vale⁸

Affiliations

¹ 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.
² 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.
³ 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.
⁴ 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.
⁵ 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.
⁶ Department of Neurology, Morton Plant Mease Hospital, 300 Pinellas Street, Clearwater, FL 33756, USA. Electronic address: drdanielcabello@gmail.com.
⁷ 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.
⁸ 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.

PMID: 26280814
DOI: 10.1016/j.yebeh.2015.07.022

Abstract

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.

Keywords: Epilepsy surgery; Laser ablation; Magnetic resonance-guided laser interstitial thermal therapy; Medically resistant epilepsy; Temporal lobe epilepsy.

MeSH terms

Age Factors
Aged
Drug Resistant Epilepsy / diagnosis*
Drug Resistant Epilepsy / therapy*
Epilepsy, Temporal Lobe / diagnosis*
Epilepsy, Temporal Lobe / therapy*
Female
Follow-Up Studies
Humans
Laser Therapy / methods*
Male
Middle Aged
Neurosurgical Procedures / methods
Prospective Studies
Treatment Outcome