MRI-guided stereotactic laser ablation of mesial temporal structures for the treatment of refractory temporal lobe epilepsy (S31.008)

Objective: To review the efficacy and safety of MRI-guided laser ablation of mesial temporal structures in patients with intractable temporal lobe epilepsy (TLE). Background: A novel surgical technique for the treatment of intractable TLE was introduced two years ago and consists on the use of MRI-guided laser ablation of mesial temporal structures. This procedure is less invasive than resective surgery and is associated with a very rapid recovery and potentially, with less post-surgical cognitive deficits. Design/Methods: Fifteen patients with intractable TLE underwent this surgical procedure between November 2013 and April 2014. Patients were followed at one, four, twelve and 24 weeks after surgery. At each visit we investigated seizure frequency, cognitive and psychiatric symptoms as well as any adverse event of AEDs. The data were collected retrospectively from the electronic medical records. The minimum post-surgical follow up period was 6 months. Results: The mean age was 44 years old, with 7 patients being > 50. One patient had bilateral independent ictal foci, with >90[percnt] of seizures from the ablated side. Another had dual pathology with an ipsilateral focal dysplasia posterior to the left hippocampus. Eleven patients have been seizure free, and two reported auras. Two patients had one breakthrough seizure after missing several days of their AEDs. There were no neurological or neurosurgical complications post-surgically. Recurrence and /or worsening of existing depression occurred in 5 patients and a hypomanic episode in one. One patient reported a mild worsening of his verbal memory. Patients above the age of 50 did not have any complications. Conclusions: Laser ablation appears to offer a minimally invasive alternative to resective surgery and could be considered especially in the elderly population. Longer follow-up periods are necessary to establish long-term efficacy of this procedure. Disclosure: Dr. Ribot has nothing to disclose. Dr. Jagid has nothing to disclose. Dr. Serrano has nothing to disclose. Dr. Lowe has nothing to disclose. Dr. Rey has nothing to disclose. Dr. Tornes has nothing to disclose. Dr. Kanner has nothing to disclose.