Can LITT Procedure Reduce Risk for SUDEP in Drug-Resistant Epilepsy?

Laser interstitial thermal therapy (LITT) was found to be suboptimal in decreasing the burden of sudden unexpected death in epilepsy (SUDEP) among patients with drug-resistant epilepsy (DRE), according to study findings published in the journal Neurology.

Minimizing incident seizures is currently the most effective strategy in preventing SUDEP. Those with DRE are at particular risk, as varied treatment modalities, including resective surgery and LITT offer varying results.

For the study, researchers sought to assess whether LITT reduces the risk for SUDEP and how recurrent seizures following LITT affect that risk among patients with DRE.

The researchers conducted a prospective observational study using 135 patients (median age, 41; 63% women) with DRE treated with LITT at the University of Washington, from 2013 to 2021. Outcomes were assessed using the clinical database, chart review, and clinical encounters.

An improved seizure burden was noted in most patients who underwent LITT. In total, 5 deaths occurred, 4 of which were attributed to SUDEP (1 death from a car crash). Of the deaths attributed to SUDEP, 3 patients had poor seizure outcomes and the fourth patient was seizure-free.

The researchers found the estimated incidence of SUDEP was 8.0 per 1,000 person-years, significantly higher than historical SUDEP incidence after resective surgery (2.0 [1.4-2.9] per 1000 person-years), and similar to surgical candidates who did not receive intervention (6.1 [4.3-8.7] per 1000 person-years).

The researchers cited historic resection cohorts that biased toward worse seizure outcomes as a possible limitation.

“These findings reinforce targeting seizure freedom to decrease SUDEP risk, including early consideration for further intervention,” the researchers wrote.

They concluded, “SUDEP rates may be less favorable with LITT compared to resective surgery, although the impact of seizure outcome and advances in LITT technique requires further study.”