This study investigated the success rate of antiepileptic drug (AED) withdrawal following Laser Interstitial Thermal Therapy (LITT) for extra temporal lobe epilepsy (ETLE), and identi?ed predictors of seizure recurrence.

Prior studies have shown a 15% success rate in AED discontinuation after stereotactic laser amygdalohippocampotomy (SLAH), but there have not been similar studies to date evaluating the success of AED withdrawal/discontinuation after LITT in ETLE.

We retrospectively assessed 22 patients who underwent LITT for ETLE.  Patients’ demographics, disease characteristics, and post-surgical outcomes were evaluated for their potential to predict seizure recurrence associated with AED withdrawal.

The mean period of observation post LITT was 33 months (range 18 - 60 months and the mean period to initial AED reduction was 7 months (range 1-36 months). AED reduction was attempted in 13 patients (59%), 4 (18%) of whom had seizure recurrence after initial reduction. At the end of the observation period, 14% of patients were seizure free without drugs, and 45% were seizure free with drugs. Compared with preoperative status, the number of AEDs were reduced in 27% of patients, unchanged in 59% of them and increased in none. Discontinuation was achieved in 3 patients (14%), and all of them remained seizure free until the ?nal assessment. Univariate analysis revealed that the age at surgery (p = .03, by independent t-test) and pre-operative seizure frequency (p = .02, by independent t-test), were associated with increased risk for seizure recurrence post AED reduction.

Successful LITT for ETLE allows for AED reduction in a significant portion of patients and complete AED withdrawal in a subset of them.  Patients with higher pre-operative seizure frequency or older age at surgery exhibit the higher chance of relapse post AED reduction.