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Author Notes:

Corresponding Author: Robert E. Gross, MD PhD, Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road NE, Suite B6200, Atlanta, GA 30322, Phone: 404-727-2354, Fax: 404-712-8576, rgross@emory.edu; Daniel L. Drane, PhD, Departments of Neurology and Pediatrics, Emory University School of Medicine, 1365 Clifton Road NE, Suite 6111, Atlanta, GA 30322, Phone: 404-727-2844, ddrane@emory.edu.

RG, MS, JW and DD contributed to the conception and/or design of the study; RG, MS, JW, RF, AS, BS, NP and DD contributed to the acquisition and/or analysis of the data; RG, MS, JW, AS, BP and DD contributed to the drafting of the text and/or preparation of the figures.

We would like to thank Deqiang Qiu, John Gale, Kelly Bijanki and our colleagues from the Emory University Biomedical Imaging Technology Center (BITC) for their support of our research, including Xiaoping Hu and Robert Smith, III.

Likewise, this research is indebted to Dr. Drane’s lab coordinator, Gloria Novak, and research assistants, Ana-Maria Eisner, Michele Price, Amanda Eakin, and Hanna Pellisier.

RG: Dr. Gross has served as a consultant to Medtronic, Monteris, MRI interventions, Visualase, Inc., and Zimmer Biomet, which manufacture products related to the research described in this paper and may be affected by this study, and receives compensation for these services. Dr. Gross received research support from Medtronic, Inc. as part of the SLATE trial (their multisite prospective trial evaluating SLAH), and has received research grants from Visualase, Inc., and MRI Interventions. The terms of these arrangements have been reviewed and approved by Emory University in accordance with its conflict of interest policies.

JW: Dr. Willie has served as a consultant to Medtronic, Inc. and MRI Interventions, Inc., and has received compensation for these services, and receives research support from Medtronic, Inc. as part of the SLATE trial. The terms of these arrangements have been reviewed and approved by Emory University in accordance with its conflict of interest policies.

RF: Dr. Fasano receives research support from Medtronic, Inc. for the SLATE trial.

DD: Dr. Drane through Emory University has received a research grant from Medtronic, Inc., and currently serves as the core lab director for their SLATE trial. The terms of these arrangements have been reviewed and approved by Emory University in accordance with its conflict of interest policies.

Authors MS, AM, BS and NP have nothing to report.

Subjects:

Research Funding:

This project was in part supported by a research grant from Visualase, Inc. [Agency Award #: VIS-10-001] and grants received by DLD from the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH) [K23 NSO49100, K02NS070960, R01NS088748], and Medtronic, Inc. [A1225797BFN:1056035].

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences
  • Neurosciences & Neurology
  • SELECTIVE AMYGDALOHIPPOCAMPECTOMY
  • SURGERY
  • ABLATION
  • MEMORY
  • ADULTS
  • TRIAL
  • OUTCOMES
  • THERAPY
  • HIPPOCAMPECTOMY
  • STIMULATION

Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy

Tools:

Journal Title:

Annals of Neurology

Volume:

Volume 83, Number 3

Publisher:

, Pages 575-587

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective: To evaluate the outcomes 1 year and longer following stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy in a large series of patients treated over a 5-year period since introduction of this novel technique. Methods: Surgical outcomes of a consecutive series of 58 patients with mesial temporal lobe epilepsy who underwent the surgery at our institution with at least 12 months of follow-up were retrospectively evaluated. A subgroup analysis was performed comparing patients with and without mesial temporal sclerosis. Results: One year following stereotactic laser amygdalohippocampotomy, 53.4% (95% confidence interval [CI] = 40.8–65.7%) of all patients were free of disabling seizures (Engel I). Three of 9 patients became seizure-free following repeat ablation. Subgroup analysis showed that 60.5% (95% CI = 45.6–73.7%) of patients with mesial temporal sclerosis were free of disabling seizures as compared to 33.3% (95% CI = 15.0–58.5%) of patients without mesial temporal sclerosis. Quality of Life in Epilepsy-31 scores significantly improved at the group level, few procedure-related complications were observed, and verbal memory outcome was better than historical open resection data. Interpretation: In an unselected consecutive series of patients, stereotactic laser amygdalohippocampotomy yielded seizure-free rates for patients with mesial temporal lobe epilepsy lower than, but comparable to, the outcomes typically associated with open temporal lobe surgery. Analogous to results from open surgery, patients without mesial temporal sclerosis fared less well. This novel procedure is an effective minimally invasive alternative to resective surgery. In the minority of patients not free of disabling seizures, laser ablation presents no barrier to additional open surgery. Ann Neurol 2018;83:575–587.

Copyright information:

© 2018 American Neurological Association

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