Magnetic resonance‐guided laser interstitial thermal therapy for drug‐resistant epilepsy: A systematic review and individual participant data meta‐analysis

Magnetic resonance‐guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug‐resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta‐analysis to identify independent p...

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Published in:Epilepsia (Copenhagen) 2023-08, Vol.64 (8), p.1957-1974
Main Authors: Chen, Jia‐Shu, Lamoureux, Audrey‐Anne, Shlobin, Nathan A., Elkaim, Lior M., Wang, Andrew, Ibrahim, George M., Obaid, Sami, Harroud, Adil, Guadagno, Elena, Dimentberg, Evan, Bouthillier, Alain, Bernhardt, Boris C., Nguyen, Dang K., Fallah, Aria, Weil, Alexander G.
Format: Article
Language:English
Subjects:
Atrophy
Convulsions & seizures
Corpus callosum
EEG
Epilepsy
Hypothalamus
Laser ablation
Magnetic resonance imaging
Meta-analysis
Neoplasia
Neuroblate
Neurological complications
Neurological diseases
outcomes
Patients
Sclerosis
seizure
Seizures
Systematic review
thermal coagulation
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Summary:Magnetic resonance‐guided laser interstitial thermal therapy (MRgLITT) has emerged as a popular minimally invasive alternative to open resective surgery for drug‐resistant epilepsy (DRE). We sought to perform a systematic review and individual participant data meta‐analysis to identify independent predictors of seizure outcome and complications following MRgLITT for DRE. Eleven databases were searched from January 1, 2010 to February 6, 2021 using the terms “MR‐guided ablation therapy” and “epilepsy”. Multivariable mixed‐effects Cox and logistic regression identified predictors of time to seizure recurrence, seizure freedom, operative complications, and postoperative neurological deficits. From 8705 citations, 46 studies reporting on 450 MRgLITT DRE patients (mean age = 29.5 ± 18.1 years, 49.6% female) were included. Median postoperative seizure freedom and follow‐up duration were 15.5 and 19.0 months, respectively. Overall, 240 (57.8%) of 415 patients (excluding palliative corpus callosotomy) were seizure‐free at last follow‐up. Generalized seizure semiology (hazard ratio [HR] = 1.78, p = .020) and nonlesional magnetic resonance imaging (MRI) findings (HR = 1.50, p = .032) independently predicted shorter time to seizure recurrence. Cerebral cavernous malformation (CCM; odds ratio [OR] = 7.97, p 
ISSN:0013-9580
1528-1167
DOI:10.1111/epi.17560