Epilepsy Division, Departments of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, USA.
Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.
Epilepsia. 2022 Apr;63(4):812-823. doi: 10.1111/epi.17183. Epub 2022 Feb 9.
Postsurgical seizure outcome following laser interstitial thermal therapy (LiTT) for the management of drug-resistant mesial temporal lobe epilepsy (MTLE) has been limited to 2 years. Furthermore, its impact on presurgical mood and anxiety disorders has not been investigated. The objectives of this study were (1) to identify seizure outcome changes over a period ranging from 18 to 81 months; (2) to investigate the seizure-free rate in the last follow-up year; (3) to identify the variables associated with seizure freedom; and (4) to identify the impact of LiTT on presurgical mood and anxiety disorders.
Medical records of all patients who underwent LiTT for MTLE from 2013 to 2019 at the University of Miami Comprehensive Epilepsy Center were retrospectively reviewed. Demographic, epilepsy-related, cognitive, psychiatric, and LiTT-related data were compared between seizure-free (Engel Class I) and non-seizure-free (Engel Class II + III + IV) patients. Statistical analyses included univariate and multivariate stepwise logistic regression analyses.
Forty-eight patients (mean age = 43 ± 14.2 years, range = 21-78) were followed for a mean period of 50 ± 20.7 months (range = 18-81); 29 (60.4%) achieved an Engel Class I outcome, whereas 11 (22.9%) had one to three seizures/year. Seizure-freedom rate decreased from 77.8% to 50% among patients with 24- and >61-month follow-up periods, respectively. In the last follow-up year, 83% of all patients were seizure-free. Seizure freedom was associated with having mesial temporal sclerosis (MTS), no presurgical focal to bilateral tonic-clonic seizures, and no psychopathology in the last follow-up year. Presurgical mood and/or anxiety disorder were identified in 30 patients (62.5%) and remitted after LiTT in 19 (62%).
LiTT appears to be a safe and effective surgical option for treatment-resistant MTLE, particularly among patients with MTS. Remission of presurgical mood and anxiety disorders can also result from LiTT.
激光间质热疗（LiTT）治疗耐药性内侧颞叶癫痫（MTLE）的术后癫痫发作结果仅限于 2 年。此外，其对术前情绪和焦虑障碍的影响尚未得到研究。本研究的目的是：（1）确定 18 至 81 个月期间的癫痫发作结果变化；（2）调查最后随访年的无癫痫发作率；（3）确定与无癫痫发作相关的变量；（4）确定 LiTT 对术前情绪和焦虑障碍的影响。
回顾性分析 2013 年至 2019 年期间在迈阿密大学综合癫痫中心接受 LiTT 治疗的所有 MTLE 患者的病历。对无癫痫发作（Engel 1 级）和有癫痫发作（Engel 2+3+4 级）患者的人口统计学、癫痫相关、认知、精神病学和 LiTT 相关数据进行比较。统计分析包括单变量和多变量逐步逻辑回归分析。
48 例患者（平均年龄 43±14.2 岁，范围 21-78）平均随访 50±20.7 个月（范围 18-81）；29 例（60.4%）达到 Engel 1 级，11 例（22.9%）每年有 1-3 次发作。在随访 24 个月和>61 个月的患者中，无癫痫发作率分别从 77.8%降至 50%。在最后一次随访年，所有患者中有 83%无癫痫发作。无癫痫发作与存在内侧颞叶硬化症（MTS）、术前无局灶性双侧强直阵挛性发作和最后一次随访年内无精神病学有关。在 30 例患者（62.5%）中发现术前情绪和/或焦虑障碍，并在 LiTT 后 19 例（62%）中缓解。
LiTT 似乎是治疗耐药性 MTLE 的一种安全有效的手术选择，尤其是在 MTS 患者中。LiTT 还可以缓解术前情绪和焦虑障碍。
