Laser interstitial thermal therapy for epileptogenic periventricular nodular heterotopia.



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OBJECTIVE: Epilepsy with periventricular nodular heterotopia (PVNH) lacks a conclusive surgical treatment strategy as eloquent cortex and important white matter tracts frequently overlay the deep periventricular nodules. Our goal was to evaluate the safety and efficacy of laser interstitial thermal therapy (LITT) for the treatment of epilepsy in PVNH.

METHODS: Data on demographic characteristics, complications, visual outcomes, Engel classification at last follow up, anti-epileptic drug use, morbidity, and mortality among patients who underwent this procedure were retrospectively reviewed.

RESULTS: Between May 2015 and January 2019, five patients underwent six LITT procedures for epilepsy with PVNH. One patient had residual nodules after their first procedure and underwent a second ablation. The average follow up time was 12 months. Three patients were Engel class Ia, one patient was Engel class II, and one patient was Engel class III at last follow up. Two patients were able to reduce their anti-epileptic drugs post-operatively. Three patients had no changes in vision, one patient experienced a quadrantanopsia, and one patient had subjective blurry vision after their procedures. No patients experienced motor deficits, dysphasia, infection, or mortality.

CONCLUSION: LITT appears to be a safe and promising option to provide seizure relief for patients with refractory epilepsy and PVNH that otherwise may not be surgical candidates. Some appropriately determined patients with refractory epilepsy may benefit from LITT before proceeding with an invasive intracranial evaluation. A larger sample size and long-term follow-up is necessary to further elucidate safety and efficacy.

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World Neurosurg



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