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Surgical outcomes between temporal, extratemporal epilepsies and hypothalamic hamartoma: systematic review and meta-analysis of MRI-guided laser interstitial thermal therapy for drug-resistant epilepsy
  1. Niravkumar Barot1,
  2. Kavita Batra2,
  3. Jerry Zhang3,
  4. Mary Lou Klem4,
  5. James Castellano5,
  6. Jorge Gonzalez-Martinez6,
  7. Anto Bagic7
  1. 1 Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  2. 2 Office of Research, University of Nevada, Las vegas, Nevada, USA
  3. 3 University of Pittsburgh, Biostatistical Consulting Laboratory, Pittsburgh, Pennsylvania, USA
  4. 4 Library System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  5. 5 Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  6. 6 Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  7. 7 Neurology, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Niravkumar Barot, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA; drniravbarot{at}


Background Approximately 1/3 of patients with epilepsy have drug-resistant epilepsy (DRE) and require surgical interventions. This meta-analysis aimed to review the effectiveness of MRI-guided laser interstitial thermal therapy (MRgLITT) in DRE.

Methods The Population, Intervention, Comparator and Outcome approach and Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. PubMed, MEDLINE and EMBASE databases were systematically searched for English language publications from 2012 to Nov 2020. Data on the prevalence outcome using the Engel Epilepsy Surgery Outcome Scale (Class I–IV), and postoperative complications were analysed with 95% CIs.

Results Twenty-eight studies that included a total of 559 patients with DRE were identified. The overall prevalence of Engel class I outcome was 56% (95% CI 0.52% to 0.60%). Hypothalamic hamartomas (HH) patients had the highest seizure freedom rate of 67% (95% CI 0.57% to 0.76%) and outcome was overall comparable between mesial temporal lobe epilepsy (mTLE) (56%, 95% CI 0.50% to 0.61%) and extratemporal epilepsy (50% 95% CI 0.40% to 0.59%). The mTLE cases with mesial temporal sclerosis had better outcome vs non-lesional cases of mTLE. The prevalence of postoperative adverse events was 19% (95% CI 0.14% to 0.25%) and the most common adverse event was visual field deficits. The reoperation rate was 9% (95% CI 0.05% to 0.14%), which included repeat ablation and open resection.

Conclusion MRgLITT is an effective and safe intervention for DRE with different disease aetiologies. The seizure freedom outcome is overall comparable in between extratemporal and temporal lobe epilepsy; and highest with HH.

Trail registration number The study protocol was registered with the National Institute for Health Research (CRD42019126365), which serves as a prospective register of systematic reviews. It is an international database of prospectively registered systematic reviews with a focus on health-related outcomes. Details about the protocol can be found at https://wwwcrdyorkacuk/PROSPERO/.

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable. No specific data generated beyond publically available studies.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable. No specific data generated beyond publically available studies.

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  • Contributors We are thankful of Apar Patel, William Welch, Dhairya Nanavati and Ankushi Sanghvi for their work with title and abstract screening. NB conceived and designed the study and wrote up the results and the discussion. MLK defined the search strategy and searched the literature. KB, WW and AP selected the studies for eligibility. AP, AS, DN, NB and KB extracted the study data. KB and AP did the assessment of the methodological quality of the included studies. NB did the qualitative synthesis, and JZ did the meta-analysis. I would like to thank the Biostatistical Consulting Laboratory at the University of Pittsburgh Graduate School of Public Health for its assistance with statistical analysis. NB wrote up the introduction. KB and JZ wrote up the methodology. AB, JG-M and JC critically reviewed the manuscript. All authors contributed to the article and approved the submitted version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JG-M is consultant for Zimmer Biomet and Dixie.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.