Pediatric Neuropsychology Postdoctoral Fellow Dell Medical School, The University of Texas at Austin | Dell Children's Medical Center Austin, Texas
Rationale: Magnetic resonance-guided laser interstitial thermal therapy (Mrg-LiTT) is a minimally invasive surgical technique for focal intractable epilepsy. A major appeal of Mrg-LITT is that it may result in fewer cognitive deficits and improved health-related quality of life (HRQOL) in comparison to respective neurosurgical approaches. However, few outcome studies exist in pediatric samples. Methods: The study included 23 patients with intractable focal epilepsy (52% male) aged six to 17 (12.48; SD = 4.12) who underwent the Mrg-LiTT procedure as well as pre- and post-surgical neuropsychological evaluation. Study measures included the Wechsler Abbreviated Intelligence Scale (WASI-II), the Grooved Pegboard test, the Behavioral Assessment System for Children (BASC-2), and the Quality of Life in Childhood Epilepsy (QOLCE). Average time to follow-up from pre-surgical evaluation was 11.48 months (SD = 4.93). Statistical analyses were conducted via paired samples t-test and Pearson correlation. Results: Sample wide intellectual, fine motor, psychological, and HRQOL outcomes remained generally unchanged at 12-month follow-up (p > .05); however, several outcomes differed by post-operative seizure control. Engel class I (27.6%) & II surgical outcome was obtained in 13 of 23 (56.5%) patients with significant improvements noted in depressive features and overall HRQOL. Specific HRQOL improvements were noted in physical activities, well-being, cognition, and social activities (p < .05), despite relatively unchanged intellectual functioning (p = .06) and stable motor functioning. For those patients with poorer post-operative seizure control (Engel class III & IV), no changes were noted in intellectual, psychological, and motor abilities; however, HRQOL was unchanged or lower (p =.06) with a significant decline in well-being (p < .01). Finally, seizure control outcomes were significantly worse when surgery involved more than one target for Mrg-LiTT (r = .43, p < .05). Otherwise, no significant differences in surgical outcomes were found across patient subgroups (hemispheric dominance, cortical pathology, or surgery side). Most common post-surgical complications included acute hemiparesis (26%) and visual field deficit (4.3%). Conclusions: The present results provide preliminary cognitive and psychological data in support of Mrg-LiTT being a relatively safe surgical approach. While seizure freedom rates are slightly lower than adult studies, this is likely accounted for by differences in the patient groups and the presence of more non-lesional cases in the pediatric cohort. Taken together, these results suggest that the Mrg-LiTT procedure is sparing of critical neurocognitive and psychological functions, and improvements in HRQOL and depressive features appear evident in children who experience worthwhile improvement in seizure control. Funding: Please list any funding that was received in support of this abstract.: N/A
