Epilepsy

Interstitial Thermal Therapy in Mesial Temporal Lobe Epilepsy

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In a prospective multicenter registry (LAANTERN), observational cohort Landazuri et al. from the University of Kansas Medical Center, Kansas City; Washington University, St. Louis; Duke University, Durham; University of Louisville, Nashville; Norton Health Care, Louisville; UT Southwestern, Dallas; Mount Sinai, New York; Yale, New Haven; University of Pittsburgh; UC San Diego; UAMS, Little Rock; Northwestern, Chicago; United Children’s St. Paul; Geisinger, Danville; AdventHealth, Orlando. published in JAMA Neurology to evaluate seizure outcomes, procedural safety, and QoL following laser interstitial thermal therapy in drug‑resistant mesial temporal lobe epilepsy. Over 50% of patients achieved Engel I or ILAE 1/2 seizure freedom at 2 years with mild, transient adverse events and QOL improvement in this large real‑world cohort

Critical Review

  • Strengths:
    • Largest prospective, multicenter US LITT registry for MTLE with 145 participants and extended 2‑year follow‑up
    • Rigorous real‑world data from 15 level IV epilepsy centers, with both adult and pediatric patients
    • Comprehensive data on procedural metrics (e.g., ablation volume, operating time, LOS) and seizure/QoL outcomes
  • Limitations:
    • No surgical comparator arm (e.g., open anterior temporal lobectomy), limiting comparative effectiveness assessment
    • Potential selection bias: centers specialized in LITT pathways and inclusion criteria requiring ≥6 months follow‑up
    • Heterogeneous etiology (MTS vs MRI‑negative) may mask subpopulation differences; no predictors of outcome identified
    • Median follow‑up limited to 2 years; long‑term seizure freedom and delayed complications remain unclear

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Total corpus callosotomy for an adult patient with progressive myoclonic epilepsy associated with dentatorubral-pallidoluysian atrophy: illustrative case

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In a single-patient illustrative case, Mine et al., from Kyushu University, Fukuoka, Japan, published in the Journal of Neurosurgery Case Lessons, report the first adult case of Dentatorubral-pallidoluysian atrophy (DRPLA)-associated progressive myoclonic epilepsy (PME) treated with a total corpus callosotomy (CC) for refractory seizures.

→ Outcome: Total CC led to a marked reduction in seizure frequency. Tonic seizures and FBTCSs with desaturation resolved by 1 year, with notable improvement in quality of life (QOL).

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🔎 Critical Appraisal

  • 🟢 Strengths
    • Novelty: First reported adult DRPLA-PME corpus callosotomy.
    • Clearly disabling epilepsy: Myoclonus, tonic seizures, desaturation.
    • Clear outcome: Sustained seizure reduction at 1-year.
  • 🟡 Limitations
    • Single case → low external validity.
    • No comparator: No data vs. anterior CC or other therapies.
    • Cognitive effects unquantified.
    • DRPLA is a diffuse neurodegenerative disease; CC does not target focus directly.

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Comparative assessment of stereoelectroencephalography and subdural electrodes in invasive epilepsy monitoring: a systematic review and meta‑analysis

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In a systematic review and metaanalysis of double‑arm comparative studies Bandopadhay et al. from the Houston Methodist Hospital published in the Journal of Neurosurgery to compare safety and seizure‑outcome profiles of stereoelectroencephalography (SEEG) vs. subdural electrodes (SDE) in pharmacoresistant epilepsy using quantitative double‑arm data SEEG demonstrated a higher rate of favorable seizure outcomes (RR 1.14, 95% CI 1.02–1.27; p=0.02) and lower complication rates overall (RR 0.49, 95% CI 0.37–0.66; p<0.00001). The benefit was significant in general adult cohorts but less pronounced in pediatric or older groups 1).

 

Critical Appraisal

* Strengths:

  • Restricting to double‑arm designs reduces cross‑study heterogeneity.
  • Large pooled cohort: 1,632 SEEG vs. 1,482 SDE patients.
  • Age‑stratified subgroup analysis adds nuance to applicability.

* Limitations:

  • Potential for publication bias—likely underreporting of negative or null comparative studies.

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Movie-watching evokes ripple-like activity within events and at event boundaries

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In a neurophysiological observational study Silva et al. from the Hospital Clínic–Barcelona, Barcelona, Spain published in Nature Communications to examine hippocampal and neocortical ripples during movie watching, and their relationship to event segmentation and later memory recall. The hippocampal ripples spike at event boundaries (linked to segmentation), while cortical ripples during events—especially in temporal cortex—predict later recall 1)

Critical Evaluation

Design & methods: – Intracranial recordings in ten epilepsy patients offer impressive temporal and spatial resolution in a naturalistic task. – However, sample size is small and patient population may limit generalizability. – Movie events are naturalistic, but segmentation boundaries may vary across subjects—analytical controls needed.

Results: – Clear increase in hippocampal ripples at event boundaries supports theories of hippocampal involvement in chunking continuous experiences. – Temporal cortex ripple rate correlation with recall is compelling—but causality is untested.

Limitations: – The patient sample’s neurological condition may alter ripple dynamics. – Lacking control comparisons (e.g., non-epileptic controls or different stimuli types). – Could benefit from linking neural dynamics more directly to behavioral performance (e.g., recall detailed metrics).

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