Abstract Details

Title Stereotactic-Guided Laser Ablation of Epileptogenic Abnormalities in Intractable Focal Epilepsy: Preliminary Results

Topic Epilepsy

Presentation(s) P04 - (-)

Poster/Presentation
Number 196

Objective

Background BACKGROUND: Resection of epileptogenic lesions is effective in treating intractable focal epilepsy. Resection usually entails a craniotomy, scalp and dural incisions which may lead to discomfort, cosmetic concerns and often entails > 3 day hospital stay. A new technique for tissue ablation using a stereotactic-guided laser-tipped catheter (Visualase®) provides the means to perform lesionectomy via a burr hole and the potential for shorter hospital stay.

Design/Methods DESIGN/METHODS: We reviewed results of stereotactic-guided laser ablation in five patients with focal epilepsy (mesial temporal sclerosis (MTS) n=3, hypothalamic hamartoma (HH) n =2).

Results RESULTS: The three MTS patients averaged 64.2 partial seizures per month prior to surgery. Median length of stay = 2 days (range, 1-5), [median length of stay for temporal lobectomy in 2011 = 3 days (range, 2-10)]. Two patients have been seizure free since surgery, one experienced multiple auras during week 1 which resolved. One patient experienced a brachial plexitis shortly after hospital discharge, thought unrelated to his procedure; one experienced an exacerbation of bipolar disorder and suicidality.Two patients with HH were treated, median length of stay = 2 days. Mean seizure frequency prior to the procedure was 41.5 partial seizures per month. One patient has had three partial seizures over the four months since surgery, the other has experienced a 50% reduction in seizure frequency. One patient was hospitalized three days after the procedure with transient fever and hyponatremia attributed to acute hypothalamic dysfunction which resolved.

Conclusions CONCLUSIONS: Stereotactic-guided laser ablation is a potential new option in the management of focal epilepsy. Potential advantages include shorter length of stay. A randomized trial comparing this technique to standard surgical management would help establish whether there are advantages in efficacy and long-term side effects over resective surgery.

Authors/Disclosures
Micaela T. Chatman, MD (Minnesota Epilepsy Group, PA) PRESENTER	No disclosure on file
Jeffrey W. Britton, MD, FAAN (Mayo Graduate School of Medicine)	Dr. Britton has received personal compensation in the range of $0-$499 for serving as a Online course with American Clinical Neurophysiology Society.
Gregory D. Cascino, MD, FAAN (Mayo Clinic)	Dr. Cascino has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for International League Against Epilepsy . Dr. Cascino has received intellectual property interests from a discovery or technology relating to health care. Dr. Cascino has received publishing royalties from a publication relating to health care. Dr. Cascino has received publishing royalties from a publication relating to health care.
Cheolsu Shin, MD (Mayo Clinic)	No disclosure on file
Gregory A. Worrell, MD (Mayo Clinic College of Medicine)	Dr. Worrell has received stock or an ownership interest from NeuroOne Inc.. Dr. Worrell has received stock or an ownership interest from Cadence Neuroscience Inc. The institution of Dr. Worrell has received research support from NIH. The institution of Dr. Worrell has received research support from Medtronic Inc.. The institution of Dr. Worrell has received research support from Neuropace Inc,. The institution of Dr. Worrell has received research support from Epilepsy Foundation of America. Dr. Worrell has received intellectual property interests from a discovery or technology relating to health care. Dr. Worrell has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
Jacqueline Bernard, MD, FAAN (Oregon Health and Sciences University)	Dr. Bernard has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Bernard has received personal compensation in the range of $500-$4,999 for serving as a Consultant for 2ND MD. Dr. Bernard has received publishing royalties from a publication relating to health care.

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