Pediatric Epilepsy Laser Ablation Shows Efficacy With Few Complications

Preliminary data from the North American pediatric epilepsy MRI-guided (MRg) laser interstitial thermal therapy (LITT, also known as laser ablation; PEP-LITT) registry presented at the American Epilepsy Society (AES) Annual Meeting, December 4–8, 2020, shows that over half of the children in the registry treated with MRgLITT achieved seizure freedom at 1-year follow-up, and permanent neurological deficits were rare.¹

These findings were presented by Elysa Widjaja, MD, MPH, pediatric neuroradiologist, The Hospital for Sick Children, associate professor, University of Toronto, and colleagues, who wrote that “Although MRgLITT is a promising therapy, the effectiveness and complication rates of MRgLITT remain uncertain,” and that “understanding the benefits and risks of MRgLITT will assist with the decision-making process on treatment options.”

The PEP-LITT registry has enrolled 129 children treated with MRgLITT from 8 pediatric epilepsy surgery centers across North America, with a mean age of 10.7 years (standard deviation [SD], 5.2). The mean age at seizure onset was 4.6 years (SD, 4.6) and the mean number of antiepileptic drugs (AEDs) was 1.9 (SD, 1.4). Abnormal MRI findings were seen in 86% (n = 111) of patients, with the most common lesion being hypothalamic hamartoma (n = 33), followed by focal cortical dysplasia (n = 23). 

Seizure outcome after 1 year was available for 93 patients, after which 56% (n = 52) of which reported seizure freedom. More than 1 MRgLITT procedure was performed in 9% (n = 12) of patients, of which 7 achieved seizure freedom. The mean length of hospital stay was 3.2 days (SD, 3.7) and the median was 1 day. 

READ MORE: Laser Ablation for Drug Resistant Epilepsy: An Effective and Minimally Invasive Surgery

Of the 129 patients, 22% (n = 28) experienced complications relating to MRgLITT – 12% (n = 16) experienced transient neurologic deficits and 2% (n = 2) experienced permanent neurologic deficits. Post MRgLITT, 1 case of 30-day mortality was reported. 

“The PEP-LITT registry will provide data for future analysis comparing seizure and health-related quality of life outcomes of MRgLITT to resective epilepsy surgery,” Widjaja and colleagues concluded.’

NeurologyLive has previously covered an investigation into the safety and efficacy of LITT in adults conducted by Patrick Landazuri, MD, director, Epilepsy Fellowship Program, department of neurology, University of Kansas, and colleagues. Landazuri and colelagues found that at 1-year follow-up, 64.3% (n = 27; 95% CI, 48–78.5) of patients in the cohort were free of disabling seizures (reaching Engel I on the Surgery Outcome Scale) and over 95% of patients had worthwhile seizure reduction (Engel I-III). The median length of stay after LITT was 32.7 hours, and head pain at discharge averaged 1.4 (SD, 2.1) on a scale from 1 to 10. Seizure worry (P = .0219) and social functioning scores (P = .0175) improved significantly at 1-year follow-up after treatment as measured of the Quality of Life (QoL) in Epilepsy questionnaire (QOLIE-31).²

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REFERENCES

1.Yossofzai O, Madsen J, Mohamed I, et al. Outcomes of North American pediatric epilepsy MRI-guided laser interstitial thermal therapy (PEP-LITT) registry. Presented at AES 2020 Annual Meeting; December 4–8, 2020. Abstract 372.
2. Landazuri P, Shih J, Leuthardt E, et. al. A prospective multicenter study of laser ablation for drug resistant epilepsy – One year outcomes. Epilepsy Res. 2020; 167. doi: 10.1016/j.eplepsyres.2020.106473