Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study.
Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study.
复制标题
颞内侧激光间质热疗治疗耐药性癫痫和随后手术治疗癫痫复发的长期结果：一项多中心队列研究。
DOI：
10.1136/jnnp-2022-330979
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Popli,
中科院分区：
文献类型：
--
作者：
Youngerman,BrettE;Banu,MateiA;Khan,Farhan;McKhann,GuyM;Schevon,CatherineA;Jagid,JonathanR;Cajigas,Iahn;Theodotou,ChristianB;Ko,Andrew;Buckley,Robert;Ojemann,JeffreyG;Miller,JohnW;Laxton,AdrianW;Couture,DanielE;Popli,
磁共振引导激光间质热疗法（MRgLITT）是一种微创手术切除耐药内侧颞叶癫痫（mTLE）的替代方法。报告的癫痫发作自由率是可变的，长期的持久性在很大程度上是未经证实的。前颞叶切除术（ATL）仍然是MRgLITT治疗失败患者的一种选择。然而，这种分阶段策略的安全性和有效性尚不清楚。方法本研究是一项多中心、回顾性队列研究，纳入了2012年至2018年在11个中心连续接受内侧颞叶MRgLITT治疗的268例患者。报告了MRgLITT和任何后续手术的发作结果和并发症。评估术前变量对癫痫发作结果的预测价值。结果随访1年（中位47个月）时，sengelⅰ型癫痫发作自由率为55.8%(149/267)，2年为52.5%(126/240)，末次随访≥1年（中位47个月）时为49.3%（132/268）。1年时Engel I或II结局达到74.2%(198/267)，2年时75.0%(180/240)，最后一次随访时66.0%（177/268）。术前局灶性到双侧强直阵挛性发作与发作复发独立相关。在癫痫复发患者中，14/21（66.7%）在后续ATL后无癫痫发作，5/10（50%）在重复MRgLITT后随访≥1年。结论smrglitt对于综合癫痫中心评估的耐药mTLE患者是一种可行的治疗方法，疗效持久。虽然癫痫发作自由率低于ATL的报道，但该系列代表了每个中心和异质队列的早期经验。ATL仍然是一种安全有效的治疗方法，用于那些经过精心挑选的MRgLITT失败的患者。
BackgroundMagnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown.MethodsThis multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed.ResultsEngel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year.ConclusionsMRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.