Epilepsy Fellow Thomas Jefferson University Hospital Baltimore, Maryland
Rationale: Magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) is increasingly becoming the preferred surgical treatment method for patients with temporal lobe epilepsy (TLE) with unilateral hippocampal sclerosis (HS). The predictors for seizure freedom after MRgLiTT of TLE-HS are unknown. We aimed to identify prognostic factors which predict outcome at one year after MRgLiTT of TLE-HS. Methods: We identified 56 patients who had undergone pre-surgical evaluation including video-EEG and had brain magnetic resonance imaging (MRI) demonstrating HS who had undergone MRgLiTT with at least one year of follow-up. The primary outcome was seizure freedom (Engel I) at one year. In order to determine predictors of outcome, we conducted multivariate analysis including the following variables: sex, duration of epilepsy, seizure frequency, generalized tonic-clonic seizures (GTC) within one year, presence of inter-ictal epileptiform discharge (IEDs), frequency of IEDs, presence of IEDs contralateral to HS and presence of periodic lateralized epileptiform discharges (PLEDs). Results: Of 56 patients who underwent MRgLiTT, 35 (62.5%) of patients were seizure free at one year. Among the surgical outcome predictors, the presence of generalized tonic-clonic seizures within one year (odds ratio [OR] 0.258, 95% CI (0.055-0.986) was associated with poor surgical outcome at one year after MRgLiTT. Conclusions: Approximately a third of patients with HS experience recurrence seizures within one year after MRgLiTT. Our findings suggest that seizure recurrence is most likely due to involvement of a broader epileptogenic network extending beyond HS. Funding: Please list any funding that was received in support of this abstract.: None
