Seizure outcome of pediatric magnetic resonance-guided laser interstitial thermal therapy versus open surgery: A matched noninferiority cohort study

Omar Yossofzai; Scellig Stone; Joseph Madsen; Rahim Moineddin; Shelly Wang; John Ragheb; Ismail Mohamed; Robert Bollo; Dave Clarke; M Scott Perry; Alexander G Weil; Jeffrey Raskin; Jonathan Pindrik; Raheel Ahmed; Sandi Lam; Aria Fallah; Cassia Maniquis; Andrea Andrade; George M Ibrahim; James Drake; James Rutka; Jignesh Tailor; Nicholas Mitsakakis; Klajdi Puka; Elysa Widjaja

doi:10.1111/epi.17451

Seizure outcome of pediatric magnetic resonance-guided laser interstitial thermal therapy versus open surgery: A matched noninferiority cohort study

Epilepsia. 2023 Jan;64(1):114-126. doi: 10.1111/epi.17451. Epub 2022 Nov 11.

Authors

Omar Yossofzai^{1

2}, Scellig Stone³, Joseph Madsen³, Rahim Moineddin⁴, Shelly Wang⁵, John Ragheb⁵, Ismail Mohamed⁶, Robert Bollo⁷, Dave Clarke⁸, M Scott Perry⁹, Alexander G Weil¹⁰, Jeffrey Raskin^{11

12}, Jonathan Pindrik¹³, Raheel Ahmed¹⁴, Sandi Lam¹², Aria Fallah¹⁵, Cassia Maniquis¹⁵, Andrea Andrade¹⁶, George M Ibrahim¹⁷, James Drake¹⁷, James Rutka¹⁷, Jignesh Tailor¹¹, Nicholas Mitsakakis¹⁸, Klajdi Puka¹⁹, Elysa Widjaja^{1

20

21}

Affiliations

¹ Department of Diagnostic Imaging, Hospital for Sick Children Toronto, Toronto, Ontario, Canada.
² Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
³ Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA.
⁴ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida, USA.
⁶ Division of Pediatric Neurology, University of Alabama, Birmingham, Alabama, USA.
⁷ Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
⁸ Department of Neurology, Dell Medical School, Austin, Texas, USA.
⁹ Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, Texas, USA.
¹⁰ Department of Neurosurgery, Saint Justine University Hospital Center, Montreal, Quebec, Canada.
¹¹ Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA.
¹² Division of Neurosurgery, Lurie Children's Hospital, Chicago, Illinois, USA.
¹³ Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio, USA.
¹⁴ Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin, USA.
¹⁵ Department of Neurosurgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA.
¹⁶ Department of Paediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada.
¹⁷ Department of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada.
¹⁸ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
¹⁹ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
²⁰ Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.
²¹ Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.

PMID: 36318088
DOI: 10.1111/epi.17451

Abstract

Objective: Minimally invasive magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been proposed as an alternative to open epilepsy surgery, to address concerns regarding the risk of open surgery. Our primary hypothesis was that seizure freedom at 1 year after MRgLITT is noninferior to open surgery in children with drug-resistant epilepsy (DRE). The secondary hypothesis was that MRgLITT has fewer complications and shorter hospitalization than surgery. The primary objective was to compare seizure outcome of MRgLITT to open surgery in children with DRE. The secondary objective was to compare complications and length of hospitalization of the two treatments.

Methods: This retrospective multicenter cohort study included children with DRE treated with MRgLITT or open surgery with 1-year follow-up. Exclusion criteria were corpus callosotomy, neurostimulation, multilobar or hemispheric surgery, and lesion with maximal dimension > 60 mm. MRgLITT patients were propensity matched to open surgery patients. The primary outcome was seizure freedom at 1 year posttreatment. The difference in seizure freedom was compared using noninferiority test, with noninferiority margin of -10%. The secondary outcomes were complications and length of hospitalization.

Results: One hundred eighty-five MRgLITT patients were matched to 185 open surgery patients. Seizure freedom at 1 year follow-up was observed in 89 of 185 (48.1%) MRgLITT and 114 of 185 (61.6%) open surgery patients (difference = -13.5%, one-sided 97.5% confidence interval = -23.8% to ∞, p_{Noninferiority} = .79). The lower confidence interval boundary of -23.8% was below the prespecified noninferiority margin of -10%. Overall complications were lower in MRgLITT compared to open surgery (10.8% vs. 29.2%, respectively, p < .001). Hospitalization was shorter for MRgLITT than open surgery (3.1 ± 2.9 vs. 7.2 ± 6.1 days, p < .001).

Significance: Seizure outcome of MRgLITT at 1 year posttreatment was inferior to open surgery. However, MRgLITT has the advantage of better safety profile and shorter hospitalization. The findings will help counsel children and parents on the benefits and risks of MRgLITT and contribute to informed decision-making on treatment options.

Keywords: drug-resistant epilepsy; laser interstitial thermal therapy; pediatric epilepsy surgery; propensity score; seizure outcome.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Child
Drug Resistant Epilepsy* / surgery
Drug Resistant Epilepsy* / therapy
Humans
Laser Therapy* / methods
Magnetic Resonance Imaging
Retrospective Studies
Seizures* / prevention & control
Treatment Outcome