Epilepsy-Related Mortality After Laser Interstitial Thermal Therapy in Patients With Drug-Resistant Epilepsy
The purpose of this report was to study the incidence of sudden unexpected death in epilepsy (SUDEP) after laser interstitial thermal therapy (LITT) for drug-resistant epilepsy (DRE). A prospective observational study of consecutive patients treated with LITT between 2013 and 2021 was conducted. The...
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| Veröffentlicht in: | Neurology 2023-09, Vol.101 (13), p.e1359-e1363 |
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| creator | Esmaeili, Behnaz Hakimian, Shahin Ko, Andrew L. Hauptman, Jason Scott Ojemann, Jeffrey G. Miller, John W. Tobochnik, Steven |
| description | The purpose of this report was to study the incidence of sudden unexpected death in epilepsy (SUDEP) after laser interstitial thermal therapy (LITT) for drug-resistant epilepsy (DRE).
A prospective observational study of consecutive patients treated with LITT between 2013 and 2021 was conducted. The primary outcome was the occurrence of SUDEP during postoperative follow-up. Surgical outcome was classified according to the Engel scale.
There were 5 deaths, including 4 SUDEPs, among 135 patients with a median follow-up duration of 3.5 (range 0.1-9.0) years and a total of 501.3 person-years at risk. The estimated incidence of SUDEP was 8.0 (95% CI 2.2-20.4) per 1,000 person-years. Three SUDEPs occurred in patients with poor seizure outcomes, whereas 1 patient was seizure-free. Compared with pooled historical data, SUDEP occurred at a higher rate than in cohorts treated with resective surgery and at a rate similar to nonsurgical controls.
SUDEP occurred early and late after mesial temporal LITT. The SUDEP rate was comparable with rates reported in epilepsy surgery candidates who did not receive intervention. These findings reinforce targeting seizure freedom to decrease SUDEP risk, including early consideration for further intervention.
This study provides Class IV evidence that LITT is not effective in reducing SUDEP incidence in patients with DRE. |
| doi_str_mv | 10.1212/WNL.0000000000207405 |
| format | Article |
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A prospective observational study of consecutive patients treated with LITT between 2013 and 2021 was conducted. The primary outcome was the occurrence of SUDEP during postoperative follow-up. Surgical outcome was classified according to the Engel scale.
There were 5 deaths, including 4 SUDEPs, among 135 patients with a median follow-up duration of 3.5 (range 0.1-9.0) years and a total of 501.3 person-years at risk. The estimated incidence of SUDEP was 8.0 (95% CI 2.2-20.4) per 1,000 person-years. Three SUDEPs occurred in patients with poor seizure outcomes, whereas 1 patient was seizure-free. Compared with pooled historical data, SUDEP occurred at a higher rate than in cohorts treated with resective surgery and at a rate similar to nonsurgical controls.
SUDEP occurred early and late after mesial temporal LITT. The SUDEP rate was comparable with rates reported in epilepsy surgery candidates who did not receive intervention. These findings reinforce targeting seizure freedom to decrease SUDEP risk, including early consideration for further intervention.
This study provides Class IV evidence that LITT is not effective in reducing SUDEP incidence in patients with DRE.</description><identifier>ISSN: 0028-3878</identifier><identifier>ISSN: 1526-632X</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000207405</identifier><identifier>PMID: 37202163</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Clinical/Scientific Note ; Drug Resistant Epilepsy - surgery ; Epilepsy - surgery ; Humans ; Laser Therapy ; Lasers ; Seizures - surgery ; Sudden Unexpected Death in Epilepsy</subject><ispartof>Neurology, 2023-09, Vol.101 (13), p.e1359-e1363</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>2023 American Academy of Neurology.</rights><rights>2023 American Academy of Neurology 2023 American Academy of Neurology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4549-f5153f2d3cb7fc936874571489508e8e3f096774aa269a54a679124be16388df3</citedby><cites>FETCH-LOGICAL-c4549-f5153f2d3cb7fc936874571489508e8e3f096774aa269a54a679124be16388df3</cites><orcidid>0000-0002-6253-9891 ; 0000-0002-2035-9876 ; 0000-0002-1310-2773 ; 0000-0001-9071-8398 ; 0000-0003-2547-0853</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,778,782,883,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37202163$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Esmaeili, Behnaz</creatorcontrib><creatorcontrib>Hakimian, Shahin</creatorcontrib><creatorcontrib>Ko, Andrew L.</creatorcontrib><creatorcontrib>Hauptman, Jason Scott</creatorcontrib><creatorcontrib>Ojemann, Jeffrey G.</creatorcontrib><creatorcontrib>Miller, John W.</creatorcontrib><creatorcontrib>Tobochnik, Steven</creatorcontrib><title>Epilepsy-Related Mortality After Laser Interstitial Thermal Therapy in Patients With Drug-Resistant Epilepsy</title><title>Neurology</title><addtitle>Neurology</addtitle><description>The purpose of this report was to study the incidence of sudden unexpected death in epilepsy (SUDEP) after laser interstitial thermal therapy (LITT) for drug-resistant epilepsy (DRE).
A prospective observational study of consecutive patients treated with LITT between 2013 and 2021 was conducted. The primary outcome was the occurrence of SUDEP during postoperative follow-up. Surgical outcome was classified according to the Engel scale.
There were 5 deaths, including 4 SUDEPs, among 135 patients with a median follow-up duration of 3.5 (range 0.1-9.0) years and a total of 501.3 person-years at risk. The estimated incidence of SUDEP was 8.0 (95% CI 2.2-20.4) per 1,000 person-years. Three SUDEPs occurred in patients with poor seizure outcomes, whereas 1 patient was seizure-free. Compared with pooled historical data, SUDEP occurred at a higher rate than in cohorts treated with resective surgery and at a rate similar to nonsurgical controls.
SUDEP occurred early and late after mesial temporal LITT. The SUDEP rate was comparable with rates reported in epilepsy surgery candidates who did not receive intervention. These findings reinforce targeting seizure freedom to decrease SUDEP risk, including early consideration for further intervention.
This study provides Class IV evidence that LITT is not effective in reducing SUDEP incidence in patients with DRE.</description><subject>Clinical/Scientific Note</subject><subject>Drug Resistant Epilepsy - surgery</subject><subject>Epilepsy - surgery</subject><subject>Humans</subject><subject>Laser Therapy</subject><subject>Lasers</subject><subject>Seizures - surgery</subject><subject>Sudden Unexpected Death in Epilepsy</subject><issn>0028-3878</issn><issn>1526-632X</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkcluFDEQhi0EIpPAGyDkI5cO3pcTikKASMMiFBRulqenOm3wdHdsN9G8fRwyGRYfXJbrr6_K_hF6QckxZZS9vvy0PCb7xYgWRD5CCyqZahRn3x-jRb02DTfaHKDDnH8QUpPaPkUHXDPCqOILFM-mEGHK2-YrRF9gjT-OqfgYyhafdAUSXvpc9_OhnnMJJfiIL3pIm1300xaHAX_xJcBQMr4Mpcdv03xVgTnk4oeCH3o8Q086HzM838Uj9O3d2cXph2b5-f356cmyaYUUtukklbxja96udNdarowWUlNhrCQGDPCOWKW18J4p66XwSlvKxArqi4xZd_wIvbnnTvNqA-u2DpZ8dFMKG5-2bvTB_ZsZQu-uxl-OEilNpVTCqx0hjdcz5OI2IbcQox9gnLNjVaWl4VpVqbiXtmnMOUG370OJu3PKVafc_07Vspd_z7gverDmD_dmjHd__zPON5BcDz6W_jdPUSoaa3fchhBrLL8F3Tqfnw</recordid><startdate>20230926</startdate><enddate>20230926</enddate><creator>Esmaeili, Behnaz</creator><creator>Hakimian, Shahin</creator><creator>Ko, Andrew L.</creator><creator>Hauptman, Jason Scott</creator><creator>Ojemann, Jeffrey G.</creator><creator>Miller, John W.</creator><creator>Tobochnik, Steven</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6253-9891</orcidid><orcidid>https://orcid.org/0000-0002-2035-9876</orcidid><orcidid>https://orcid.org/0000-0002-1310-2773</orcidid><orcidid>https://orcid.org/0000-0001-9071-8398</orcidid><orcidid>https://orcid.org/0000-0003-2547-0853</orcidid></search><sort><creationdate>20230926</creationdate><title>Epilepsy-Related Mortality After Laser Interstitial Thermal Therapy in Patients With Drug-Resistant Epilepsy</title><author>Esmaeili, Behnaz ; Hakimian, Shahin ; Ko, Andrew L. ; Hauptman, Jason Scott ; Ojemann, Jeffrey G. ; Miller, John W. ; Tobochnik, Steven</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4549-f5153f2d3cb7fc936874571489508e8e3f096774aa269a54a679124be16388df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Clinical/Scientific Note</topic><topic>Drug Resistant Epilepsy - surgery</topic><topic>Epilepsy - surgery</topic><topic>Humans</topic><topic>Laser Therapy</topic><topic>Lasers</topic><topic>Seizures - surgery</topic><topic>Sudden Unexpected Death in Epilepsy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Esmaeili, Behnaz</creatorcontrib><creatorcontrib>Hakimian, Shahin</creatorcontrib><creatorcontrib>Ko, Andrew L.</creatorcontrib><creatorcontrib>Hauptman, Jason Scott</creatorcontrib><creatorcontrib>Ojemann, Jeffrey G.</creatorcontrib><creatorcontrib>Miller, John W.</creatorcontrib><creatorcontrib>Tobochnik, Steven</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Esmaeili, Behnaz</au><au>Hakimian, Shahin</au><au>Ko, Andrew L.</au><au>Hauptman, Jason Scott</au><au>Ojemann, Jeffrey G.</au><au>Miller, John W.</au><au>Tobochnik, Steven</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epilepsy-Related Mortality After Laser Interstitial Thermal Therapy in Patients With Drug-Resistant Epilepsy</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2023-09-26</date><risdate>2023</risdate><volume>101</volume><issue>13</issue><spage>e1359</spage><epage>e1363</epage><pages>e1359-e1363</pages><issn>0028-3878</issn><issn>1526-632X</issn><eissn>1526-632X</eissn><abstract>The purpose of this report was to study the incidence of sudden unexpected death in epilepsy (SUDEP) after laser interstitial thermal therapy (LITT) for drug-resistant epilepsy (DRE).
A prospective observational study of consecutive patients treated with LITT between 2013 and 2021 was conducted. The primary outcome was the occurrence of SUDEP during postoperative follow-up. Surgical outcome was classified according to the Engel scale.
There were 5 deaths, including 4 SUDEPs, among 135 patients with a median follow-up duration of 3.5 (range 0.1-9.0) years and a total of 501.3 person-years at risk. The estimated incidence of SUDEP was 8.0 (95% CI 2.2-20.4) per 1,000 person-years. Three SUDEPs occurred in patients with poor seizure outcomes, whereas 1 patient was seizure-free. Compared with pooled historical data, SUDEP occurred at a higher rate than in cohorts treated with resective surgery and at a rate similar to nonsurgical controls.
SUDEP occurred early and late after mesial temporal LITT. The SUDEP rate was comparable with rates reported in epilepsy surgery candidates who did not receive intervention. These findings reinforce targeting seizure freedom to decrease SUDEP risk, including early consideration for further intervention.
This study provides Class IV evidence that LITT is not effective in reducing SUDEP incidence in patients with DRE.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>37202163</pmid><doi>10.1212/WNL.0000000000207405</doi><orcidid>https://orcid.org/0000-0002-6253-9891</orcidid><orcidid>https://orcid.org/0000-0002-2035-9876</orcidid><orcidid>https://orcid.org/0000-0002-1310-2773</orcidid><orcidid>https://orcid.org/0000-0001-9071-8398</orcidid><orcidid>https://orcid.org/0000-0003-2547-0853</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Clinical/Scientific Note Drug Resistant Epilepsy - surgery Epilepsy - surgery Humans Laser Therapy Lasers Seizures - surgery Sudden Unexpected Death in Epilepsy |
| title | Epilepsy-Related Mortality After Laser Interstitial Thermal Therapy in Patients With Drug-Resistant Epilepsy |
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