Laser interstitial thermal therapy for refractory epilepsy

In 2 presentations at the AAN 2022, laser interstitial thermal therapy (LITT) was evaluated as an upcoming, minimally-invasive treatment option for refractory epilepsy. LITT was found to be safe in carefully selected patients. Careful management of post-operative seizures and discharge planning after epilepsy surgery may be important to optimise outcomes and reduce the risk of readmission.

A first study reported the trends and outcomes in the USA after surgical procedures for refractory epilepsy [1]. LITT has the advantage of being minimally invasive and is increasingly used for different brain lesions, offering seizure outcomes comparable with those of more traditional open surgery. In order to compare LITT to other procedures, all adult refractory epilepsy patients in the Nationwide Readmission Database were included who had either open surgery or LITT and were then readmitted within a month after discharge between 2012 and 2018.

Of 205,966 patients with refractory epilepsy, 3.1% (n=7,950) underwent either LITT (7.6%) or an open-surgical procedure (92.4%) which included lobectomy, partial lobectomy, or amygdalohippocampectomy. LITT was associated with a shorter hospital stay, a higher likelihood of being discharged, lower readmission rate, and lower costs. In the LITT group, 6.3% were readmitted to hospital within 30 days, this was 9.2% in the open-surgery group. Median length of stay after readmission was 1 day and 4 days, respectively. Incidence of post-operative infections was 13% versus 26.5% (CNS infection 3.0% vs 5.2%), and incidence of disposition to facility was 2.4% versus 7.9%. A higher rate of uncontrolled epilepsy-related readmission was present in patients treated with LITT (47.8% vs 27.1%) and LITT had a lower treatment response rate (7.6% vs 92.4%).

In another analysis with data from the Nationwide Readmission Database,  about 1 in 10 RE patients who underwent LITT between 2010 and 2018 were readmitted within 30 days of discharge [2]. The most common reasons were persistent epilepsy (24.8%) and post-operative infections (22.6%). The incidence of post-operative blood transfusion, CNS infections and CNS complications was higher in patients who were readmitted.

Prof. Varun Kumar (Icahn School of Medicine at Mount Sinai, NY, USA) concluded that in carefully selected refractory epilepsy patients, LITT is a relatively safe treatment option [1]. Careful management of post-operative seizures and discharge planning after epilepsy surgery may further optimise outcomes and reduce the risk of readmission for these patients [1,2].

1. Kumar V, et al. Comparison of nationwide trends in 30-day readmission rates after laser interstitial thermal therapy (LITT) and open surgical procedures for refractory epilepsy (Nationwide Readmission database 2012-2018). S24.004, AAN 2022, 02–07 April, Seattle, USA.


2. Kumar V, et al. Outcomes and Resource Utilization Associated with Readmissions after laser interstitial thermal therapy for refractory epilepsy: A Nationwide Readmission database study (2010-2018). S24.007, AAN 2022, 02–07 April, Seattle, USA.

Copyright ©2022 Medicom Medical Publishers





Posted on 2 June, 2022