Clinical Predictors of One-Year Seizure Freedom After SLAH

A study published in Annals of Clinical and Translational Neurology aimed to predict 1-year seizure freedom for patients undergoing stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE) using a set of clinical predictors.

The study sought to improve patient selection for this minimally invasive procedure, which presents as an alternative to the traditional open anterior temporal lobectomy (ATL). While SLAH is linked to fewer cognitive deficits than ATL, seizure freedom after SLAH is achieved less frequently (57% vs 69%). Therefore, identifying patients who are most likely to benefit from SLAH is essential.

Rsearchers selected 8 predictors of seizure freedom in patients who underwent SLAH at Emory University from 2011 to 2019, including MRI evidence of mesial temporal sclerosis (MTS) and unitemporal interictal discharges. They tested 4 multivariate models: MTS, using only the presence of MTS on MRI; FULL, using all eight predictors; AIC, using backward selection to identify optimal predictors; and SCORE, which assigned points to each predictor.

Of the patients in this cohort, 49.5% achieved seizure freedom after 1 year. Univariate analysis showed that MTS and unitemporal interictal discharges were significant predictors for seizure freedom. Researchers concluded that combining multiple clinical variables into an ordinal score model yields better predictions of seizure freedom after SLAH than models based on MTS alone or complex multivariate models. They found that the SCORE model may help identify candidates for SLAH, with patients scoring 6 or above having a 70% to 80% chance of being seizure-free, comparable to the success rate of more invasive ATL surgery.

Future research may improve this predictive model by including additional clinical data. “Our overall conclusion is that the concordance of multiple clinical datapoints better predicts seizure freedom after SLAH than any one datapoint alone. Future research will incorporate additional data—such as semiology and neuropsychological profile—into the ordinal score described here,” researchers concluded.

Reference

Dickey AS, Bullinger KL, Grogan D, et al. An ordinal clinical score predicts seizure freedom after minimally invasive epilepsy surgery. Ann Clin Transl Neurol. 2024;11(9):2327-2336. doi:10.1002/acn3.52146