Postoperative Outcomes of Magnetic Resonance Imaging (MRI)-Guided Laser Interstitial Thermal Therapy (LITT) in the Treatment of Drug-Resistant Epilepsy: A Meta-Analysis

BACKGROUND: Drug-resistant epilepsy is a common neurological disease in adults and children. This study aimed to undertake a systematic review of the literature with meta-analysis of the data from published studies to assess the effectiveness of magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (LITT) in treatment-resistant epilepsy.
MATERIAL AND METHODS: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, MEDLINE, and EMBASE databases were systematically searched for indexed publications in the English language up to May 2018. Data on the prevalence, outcome using the Engel Epilepsy Surgery Outcome Scale (Class I to IV), and postoperative complications were analyzed with 95% confidence intervals (CIs). The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the risk of bias in the included studies.
RESULTS: Sixteen published studies that included a total of 269 patients with treatment resistant epilepsy were identified. The prevalence of Engel Class I, II, III and IV were 61% (95% CI, 0.54–0.68; I²=14.5%; P=0.302), 12% (95% CI, 0.07–0.16; I²=86.8%; P=0.000), 16% (95% CI, 0.10–0.22; I²=3.0%; P=0.397), and 15% (95% CI, 0.08–0.22; I²=13.2%; P=0.330), respectively. The prevalence of postoperative complications was 24% (95% CI, 0.16–0.32; I2=0%; P=0.629).
CONCLUSIONS: Meta-analysis of data from 16 studies that included 269 patients with treatment-resistant epilepsy showed that MRI-guided LITT significantly reduced the frequency of seizures and reduced postoperative complications, supporting the safety and effectiveness of MRI-guided LITT in the treatment of drug-resistant epilepsy.

Keywords: Epilepsies, Partial, Epilepsy, Absence, Laser Therapy, Magnetic Resonance Imaging, meta-analysis