Epilepsia: To compare the prognosis of MRgLITT with open surgery for drug-refractory epilepsy

Minimally invasive magnetic resonance-guided laser interstitial hyperthermia (MRgLITT) has been proposed as an alternative to open epilepsy surgery to address questions
about the risks of open surgery.
The journal Epilepsia published a study with the primary objective of comparing MRgLITT with open surgery in children with
drug-refractory epilepsy (DRE).
Secondary objectives were to compare complications and length
of hospital stay between the two treatments.

This retrospective multicenter cohort study included children with DRE treated with MRgLITT or open surgery with 1 year
follow-up.
Exclusion criteria were corpus callosotomy, nerve stimulation, multilobar or hemispherical surgery, and lesions
with a maximum size greater than 60 mm.
MRgLITT tends to be matched
with open surgery patients.
The primary outcome was seizure-free
for one year after treatment.
The non-inferiority test was used to compare the difference in seizure-free with a cut-off of -10%.

Secondary outcomes were complications and length of
hospital stay.

185 MRgLITT patients were matched with
185 patients with open surgery.
In the matching cohort, the mean ages of MRgLITT and surgical patients were 11.
3±4.
8 and 11.
0±5.
0 years
, respectively.

At 1-year follow-up, 89/185 (48.
1%) patients with MRgLITT and 114/185 (61.
6%) patients with open surgery were seizure-free (difference = -13.
5%, unilateral 97.
5% CI: -23.
8% to ∞, P _{non-inferiority} = 0.
79).

The lower bound of the confidence interval is -23.
8%, which is lower than the predetermined non-inferiority cut-off of -10%.

Compared with open surgery, MRgLITT was significantly lower associated
with cortical developmental malformations without seizures (26/60 (43.
3%) vs 46/60 (76.
7%), p < 0.
001) and 20~40 mm lesion size (24/65 (36.
9%) vs 38/60 (63.
3%), p = 0.
006, respectively).
。 After MRgLIT, temporal lobe epilepsy (40/77 (51.
9%) vs 54/81 (66.
7%), p = 0.
09), extratemporal lobe epilepsy (49/108 (45.
4%) vs 60/104 (57.
7%), p = 0.
10), hippocampal sclerosis (15/32 (46.
9%) vs 25/35 (71.
4%), p = 0.
07), tumor (14/20 (70.
0%), respectively Seizure-free rates were lower but not statistically significant,
with lesion size ≤ 20 mm (58/108 (53.
7%), p = 0.
47), and lesion size > 40 mm (7/12 (58.
3%), vs 12/17 (70.
6%), p = 0.
77, respectively.

The overall complication rate of MRgLITT was lower than that of open surgery (10.
8 versus 29.
2 percent, p < 0.
001).

MRgLITT had a shorter hospital stay than open surgery (3.
1±2.
9 vs 7.
2±6.
1 days, p < 0.
001).

After 1 year of treatment, MRgLITT had a worse seizure outcome than open surgery
.
However, MRgLITT has a better safety profile and shorter hospital
stay.
The findings will help inform children and parents about the benefits and risks of MRgLITT and help make informed decisions
about treatment options.

Original source:

Omar Yossofzai, Scellig Stone, et al, Seizure Outcome of Pediatric MR-guided Laser Interstitial Thermal Therapy versus Open Surgery: A Matched Non-Inferiority Cohort Study, Epilepsia, 2022, https://doi.
org/10.
1111/epi.
17451.