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WASHINGTON, DC—Stereotactic laser ablation may result in better cognitive outcomes in patients with temporal lobe epilepsy than treatment with standard open surgical approaches, researchers reported at the 67th Annual Meeting of the American Epilepsy Society.
In a study comparing pre- and post-treatment cognitive outcomes in 17 people with temporal lobe epilepsy, participants who received MRI-guided laser ablation had better outcomes on episodic memory measures at six months than patients treated with standard surgical treatments did, said Daniel Drane, PhD, Assistant Professor in the Departments of Neurology and Pediatrics at Emory University in Atlanta. The results suggest that “memory decline requires broader damage to mesial temporal lobe structures or that epilepsy patients are able to reorganize memory more efficiently if structural damage is more selective,” he concluded.
Comparing Standard Surgery With Laser Ablation in 17 Patients
Dr. Drane and colleagues compared neuropsychologic data before surgery and six months after surgery for seven people who were treated with hippocampal laser ablation (including five patients with left resections and two patients with right resections) and 10 people who underwent surgery with standard or selective surgical approaches such as selective amygdalohippocampectomy (including five patients with left resections and five patients with right resections). Patients in both groups were similar in age (mean age, 36 to 39) and were on a mean of two antiepileptic drugs. Two patients in the surgery group and three in the laser ablation group had had seizures since the age of 5 or earlier. The investigators evaluated episodic memory with measures that included tasks of visual and verbal memory.
After treatment, the researchers saw evidence of a significant decline in one or both memory tasks in one of the seven patients treated with laser ablation, compared with nine of the 10 surgical patients. The difference between the groups was statistically significant, said Dr. Drane. In addition, six patients who had laser ablation showed a significant improvement in one or more memory measures after treatment, compared with four patients who received standard surgery.
Laser Ablation Is Associated With Short Hospital Stays
Considering “the presumed importance of the hippocampus in episodic memory, we were surprised by the absence of any decline” in the laser ablation group, said Dr. Drane. The study results suggest that the function of the hippocampus may not be completely understood “and that being able to perform such a precise resection may help us learn more about brain regions in a manner that was never before possible in humans,” he added.
Laser ablation’s benefits, compared with standard surgical procedures, include less pain and a shorter hospital stay (ie, a median of one day) with no time spent in the ICU, noted Dr. Drane. Another possible benefit of the less-invasive procedure is a positive effect on mood, he added. A patient in her early 60s with chronic epilepsy and chronic depression was completely seizure-free after laser ablation. For this patient, the most striking result of treatment was that she was no longer depressed and discontinued all antidepressants for the first time since she was a teenager. This case suggests that a procedure that does not affect “so many regions” of the brain may benefit mood, concluded Dr. Drane.
—Elizabeth Mechcatie
WASHINGTON, DC—Stereotactic laser ablation may result in better cognitive outcomes in patients with temporal lobe epilepsy than treatment with standard open surgical approaches, researchers reported at the 67th Annual Meeting of the American Epilepsy Society.
In a study comparing pre- and post-treatment cognitive outcomes in 17 people with temporal lobe epilepsy, participants who received MRI-guided laser ablation had better outcomes on episodic memory measures at six months than patients treated with standard surgical treatments did, said Daniel Drane, PhD, Assistant Professor in the Departments of Neurology and Pediatrics at Emory University in Atlanta. The results suggest that “memory decline requires broader damage to mesial temporal lobe structures or that epilepsy patients are able to reorganize memory more efficiently if structural damage is more selective,” he concluded.
Comparing Standard Surgery With Laser Ablation in 17 Patients
Dr. Drane and colleagues compared neuropsychologic data before surgery and six months after surgery for seven people who were treated with hippocampal laser ablation (including five patients with left resections and two patients with right resections) and 10 people who underwent surgery with standard or selective surgical approaches such as selective amygdalohippocampectomy (including five patients with left resections and five patients with right resections). Patients in both groups were similar in age (mean age, 36 to 39) and were on a mean of two antiepileptic drugs. Two patients in the surgery group and three in the laser ablation group had had seizures since the age of 5 or earlier. The investigators evaluated episodic memory with measures that included tasks of visual and verbal memory.
After treatment, the researchers saw evidence of a significant decline in one or both memory tasks in one of the seven patients treated with laser ablation, compared with nine of the 10 surgical patients. The difference between the groups was statistically significant, said Dr. Drane. In addition, six patients who had laser ablation showed a significant improvement in one or more memory measures after treatment, compared with four patients who received standard surgery.
Laser Ablation Is Associated With Short Hospital Stays
Considering “the presumed importance of the hippocampus in episodic memory, we were surprised by the absence of any decline” in the laser ablation group, said Dr. Drane. The study results suggest that the function of the hippocampus may not be completely understood “and that being able to perform such a precise resection may help us learn more about brain regions in a manner that was never before possible in humans,” he added.
Laser ablation’s benefits, compared with standard surgical procedures, include less pain and a shorter hospital stay (ie, a median of one day) with no time spent in the ICU, noted Dr. Drane. Another possible benefit of the less-invasive procedure is a positive effect on mood, he added. A patient in her early 60s with chronic epilepsy and chronic depression was completely seizure-free after laser ablation. For this patient, the most striking result of treatment was that she was no longer depressed and discontinued all antidepressants for the first time since she was a teenager. This case suggests that a procedure that does not affect “so many regions” of the brain may benefit mood, concluded Dr. Drane.
—Elizabeth Mechcatie
WASHINGTON, DC—Stereotactic laser ablation may result in better cognitive outcomes in patients with temporal lobe epilepsy than treatment with standard open surgical approaches, researchers reported at the 67th Annual Meeting of the American Epilepsy Society.
In a study comparing pre- and post-treatment cognitive outcomes in 17 people with temporal lobe epilepsy, participants who received MRI-guided laser ablation had better outcomes on episodic memory measures at six months than patients treated with standard surgical treatments did, said Daniel Drane, PhD, Assistant Professor in the Departments of Neurology and Pediatrics at Emory University in Atlanta. The results suggest that “memory decline requires broader damage to mesial temporal lobe structures or that epilepsy patients are able to reorganize memory more efficiently if structural damage is more selective,” he concluded.
Comparing Standard Surgery With Laser Ablation in 17 Patients
Dr. Drane and colleagues compared neuropsychologic data before surgery and six months after surgery for seven people who were treated with hippocampal laser ablation (including five patients with left resections and two patients with right resections) and 10 people who underwent surgery with standard or selective surgical approaches such as selective amygdalohippocampectomy (including five patients with left resections and five patients with right resections). Patients in both groups were similar in age (mean age, 36 to 39) and were on a mean of two antiepileptic drugs. Two patients in the surgery group and three in the laser ablation group had had seizures since the age of 5 or earlier. The investigators evaluated episodic memory with measures that included tasks of visual and verbal memory.
After treatment, the researchers saw evidence of a significant decline in one or both memory tasks in one of the seven patients treated with laser ablation, compared with nine of the 10 surgical patients. The difference between the groups was statistically significant, said Dr. Drane. In addition, six patients who had laser ablation showed a significant improvement in one or more memory measures after treatment, compared with four patients who received standard surgery.
Laser Ablation Is Associated With Short Hospital Stays
Considering “the presumed importance of the hippocampus in episodic memory, we were surprised by the absence of any decline” in the laser ablation group, said Dr. Drane. The study results suggest that the function of the hippocampus may not be completely understood “and that being able to perform such a precise resection may help us learn more about brain regions in a manner that was never before possible in humans,” he added.
Laser ablation’s benefits, compared with standard surgical procedures, include less pain and a shorter hospital stay (ie, a median of one day) with no time spent in the ICU, noted Dr. Drane. Another possible benefit of the less-invasive procedure is a positive effect on mood, he added. A patient in her early 60s with chronic epilepsy and chronic depression was completely seizure-free after laser ablation. For this patient, the most striking result of treatment was that she was no longer depressed and discontinued all antidepressants for the first time since she was a teenager. This case suggests that a procedure that does not affect “so many regions” of the brain may benefit mood, concluded Dr. Drane.
—Elizabeth Mechcatie
