TY - JOUR
T1 - Intraoperative electrocorticography during laser-interstitial thermal therapy predicts seizure outcome in mesial temporal lobe epilepsy
AU - Chen, Baibing
AU - Grewal, Sanjeet S.
AU - Middlebrooks, Erik H.
AU - Tatum, William O.
AU - Ritaccio, Anthony L.
AU - Sirven, Joseph I.
AU - Freund, Brin E.
AU - Feyissa, Anteneh M.
N1 - Funding Information:
We thank the individuals who consented to participate in this research. The authors thank the clinical and surgical staff of the Departments of Neurology and Neurosurgery for their excellent technical expertise and dedication to patient care in the clinic, the hospital wards, and the operating room throughout this study.
Publisher Copyright:
© 2022 International Federation of Clinical Neurophysiology
PY - 2023/2
Y1 - 2023/2
N2 - Objective: Magnetic resonance-guided laser interstitial thermal therapy (MRLiTT) for treating temporal lobe epilepsy has recently gained popularity. We aimed to investigate the predictive value of pre-and post-MRLiTT epileptiform discharges (EDs) on intraoperative electrocorticography (iECoG) in seizure outcomes for patients with mesial temporal lobe epilepsy (mTLE). Methods: We conducted a pilot, prospective single-center cohort study on seven consecutive patients with mTLE that underwent MRLiTT. Pre- and post-MRLiTT iECoG was performed using a 1x8 contact depth electrode along the same trajectory used for the laser catheter. Results: The responders had a robust reduction in ED frequency compared to pre-MRLiTT iECoG (86% vs 13%, p < 0.01). Clinical characteristics, including risk factors for epilepsy, duration of epilepsy, presence of mesial temporal lobe sclerosis, prior intracranial monitoring, the absolute frequency of pre- or post-MRLiTT EDs, and ablation volume were not significantly associated with responder status. Conclusions: This is the first demonstration that intraoperative reduction in EDs during mesial temporal lobe MRLiTT may potentially predict seizure outcomes and may serve as an intraoperative biomarker for satisfactory ablation. However, larger prospective studies are needed to confirm our findings and evaluate the utility of iECoG during MRLiTT. Significance: iECoG during mesial temporal lobe MRLiTT may help assess seizure outcomes.
AB - Objective: Magnetic resonance-guided laser interstitial thermal therapy (MRLiTT) for treating temporal lobe epilepsy has recently gained popularity. We aimed to investigate the predictive value of pre-and post-MRLiTT epileptiform discharges (EDs) on intraoperative electrocorticography (iECoG) in seizure outcomes for patients with mesial temporal lobe epilepsy (mTLE). Methods: We conducted a pilot, prospective single-center cohort study on seven consecutive patients with mTLE that underwent MRLiTT. Pre- and post-MRLiTT iECoG was performed using a 1x8 contact depth electrode along the same trajectory used for the laser catheter. Results: The responders had a robust reduction in ED frequency compared to pre-MRLiTT iECoG (86% vs 13%, p < 0.01). Clinical characteristics, including risk factors for epilepsy, duration of epilepsy, presence of mesial temporal lobe sclerosis, prior intracranial monitoring, the absolute frequency of pre- or post-MRLiTT EDs, and ablation volume were not significantly associated with responder status. Conclusions: This is the first demonstration that intraoperative reduction in EDs during mesial temporal lobe MRLiTT may potentially predict seizure outcomes and may serve as an intraoperative biomarker for satisfactory ablation. However, larger prospective studies are needed to confirm our findings and evaluate the utility of iECoG during MRLiTT. Significance: iECoG during mesial temporal lobe MRLiTT may help assess seizure outcomes.
KW - Drug-resistant epilepsy
KW - EEG
KW - Electroencephalogram
KW - Focal epilepsy
KW - Laser ablation
KW - Seizure freedom
KW - Temporal lobe epilepsy
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U2 - 10.1016/j.clinph.2022.12.003
DO - 10.1016/j.clinph.2022.12.003
M3 - Article
C2 - 36608529
AN - SCOPUS:85145691065
SN - 1388-2457
VL - 146
SP - 118
EP - 123
JO - Electroencephalography and Clinical Neurophysiology - Electromyography and Motor Control
JF - Electroencephalography and Clinical Neurophysiology - Electromyography and Motor Control
ER -