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Stereotaktische Laserablation für fokale Epilepsien

Eine Literaturübersicht

Stereotactic laser ablation for focal epilepsy

A literature review

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Zusammenfassung

Hintergrund

Die stereotaktische Laserablation (sLA) ist eine neue Therapieoption für pharmakorefraktäre Epilepsien. Aufgrund ihres minimalinvasiven Charakters ist sie in den Fokus aktueller Publikationen gerückt.

Ziel der Arbeit

Übersicht der verfügbaren klinischen Ergebnisse der sLA.

Material und Methoden

Eine systematische Literaturrecherche ermöglichte einen Überblick über die aktuellen Veröffentlichungen bis September 2016. Einzelne Aspekte wie Indikationsgebiete, Anfalls- und neuropsychologisches Outcome sowie Komplikationen werden zusammengefasst.

Ergebnisse

In 27 Publikationen wurden Ergebnisse von 184 Patienten veröffentlicht, wobei Temporallappenepilepsien (TLE; N = 105), hypothalamische Hamartome (HH; N = 28) und fokale kortikale Dysplasien (FCD; N = 15) die häufigsten Syndrome waren. Follow-up-Daten für >1 Jahr lagen insgesamt für 58 Patienten vor, wobei sich für TLE (N = 28) und FCD (N = 12) ein Engel-Outcome 1 von 57–58 % und für HH (N = 5) von 100 % ergab. Die Komplikationsrate war vergleichbar mit resektiven Verfahren, allerdings zeigte sich eine deutlich verringerte Krankenhausaufenthaltsdauer.

Diskussion

Insgesamt erweist sich die sLA als sicheres Verfahren mit einer geringen postoperativen Belastung für den Patienten. Das Anfalls-Outcome scheint syndromabhängig zu sein. Angesichts der Aktualität des Verfahrens sind größere Kohorten notwendig, um genauere Aussagen machen zu können.

Abstract

Background

The MR-guided laser interstitial thermal therapy (MRgLITT) is a novel therapeutic approach for pharmacoresistant epilepsy patients. Due to its minimally invasive approach the method has recently been the subject of growing interest.

Objective

Review of the available publications for MRgLITT.

Material and methods

Based on a systematic literature search the present article gives an overview of the current original and conference publications up to September 2016. Results are summarized with respect to postsurgical seizures and neuropsychological outcome, reported side effects and different indications for which the method has been used.

Results

Results from 184 patients were published in 27 articles, with temporal lobe epilepsy (TLE, N = 105), hypothalamic hamartoma (HH, N = 28) and focal cortical dysplasia (FCD, N = 15) being the most frequent. Of the patients 56 were followed for at least 1 year postsurgery, with seizure freedom rates for TLE (N = 28) and FCD (N = 12) of 57–58% and for HH (N = 5) of 100%. While the rate of adverse events was comparable to resection procedures, the hospitalization time was significantly shorter.

Discussion

In summary, MRgLITT appears to be a safe procedure with few disadvantages for the patient. Seizure outcome might depend on the epileptic syndrome; however, a bigger cohort is necessary to draw reliable conclusions.

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Authors and Affiliations

  1. Universitätsklinik für Neurologie, Otto-von-Guericke-Universität, Leipzigerstr. 44, 39120, Magdeburg, Deutschland

    Arne Ilse &  Friedhelm C. Schmitt MD

  2. Universitätsklinik für Stereotaktische Neurochirurgie, Otto-von-Guericke-Universität, Magdeburg, Deutschland

    Lars Büntjen

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Correspondence to Friedhelm C. Schmitt MD.

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Interessenkonflikt

A. Ilse und L. Büntjen geben an, dass kein Interessenkonflikt besteht. F.C. Schmitt hat von Medtronic Inc. Aufwand- und Reiseentschädigungen für Vorträge erhalten.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Ilse, A., Büntjen, L. & Schmitt, F.C. Stereotaktische Laserablation für fokale Epilepsien. Z. Epileptol. 30, 152–161 (2017). https://doi.org/10.1007/s10309-017-0113-6

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