Abstracts

Rationale: - Stereotactic laser ablation is a relatively newer treatment option for medically refractory epilepsy, although it has been developed since 1980s. - Surgical resection in temporal lobe epilepsy randomized controlled trials has shown that seizure freedom is achieved more in patients with surgical resection as compared to pts who are continued on prolonged medications. - The severity of impairing seizures was also lower in surgically treated group. - Minimally invasive surgery can be a better option than open surgeries as it decreases - cost of procedure, co morbidities associated with open surgery, including neuro cognitive deficits post op, reduced hospital stay, better quality of life. Methods: - This is a retrospective, single center, outcome research, studying patients who had laser ablation surgeries. - 19 patients were selected after careful pre surgical evaluation with VEEG and/or SEEG monitoring, MRI, PET scan, Ictal and Interictal SPECT, Neuropsych evaluation, Wada testing for language and memory localization, who underwent stereotactic laser ablation fro refractory epilpesy. Patients with extra temporal epilpetic focus, who recieved laser ablation surgery, were excluded from the study. - Patients were charted for baseline characteristics like age of onset, age of surgery, seizure types, previous/current AEDs, risk factors, developmental history, social history and education, length of hospital stay, post op complications, post op changes in neuro psych eval after 1 year of surgery, changes in quality of life, depression scale and anxiety scale, pre and post surgery. Patients were graded under Engel classification of seizure freedom after undergoing the procedure. Results: Seizure freedom rates- Results 6 months post Op- 17 out of 19 patients had no szs or class I outcome- 89%,1 patient had class II outcome, 1 patient had class III outcome.Results 1 year post op- 11 patients had no szs or class I- 57%, 5 patinest had class II outcome, 3 patients had class III outcome.Neuro psych outcomes- Out of 19, 4 patients did not get post op neuro psych eval. 1 patinet had no neuropsych pre op eval, only had per op Wada test.Tests used- Verbal Memory- List Learning Test- CVLT-II, RAVLT, HVLT-R, WRAML-2, Logical Memory- WMS- Wechsler Memory scale, Visual Memory test- BVMT, WMS - IV, Ray osctrich complex fig test, NAB memory shape, Quality of Life scale- QoL, Depression scale- PHq9 or BECK, Anxiety - GAD scale.Results- For Verbal memory and logical memory - higher percentage had decrease in post op outcome, But for Visual memory- higher percentage of patients had better outcomes post op. In our study, higher perentage of patients had same quality of life post op, but exprerienced decrease in deppression and anxiety symptoms. Conclusions: - The overall 57% rate of seizure freedom is consistent with other published series, which reported Seizure freedom rates between 54% and 65%. Seizure freedom rates with SLAH appear to be slightly lower than with ATL, the gold standard surgical treatment for MTLE, which has been demonstrated in rates ranging from 60% to 80% in appropriately chosen patients in large clinical trials in carefully selected patients. Possibly greater effectiveness of open resection must be balanced against the potentially greater risk of neuropsychological decline from collateral injury to the temporal stem. Funding: No funding