Cognitive outcomes after magnetic resonance-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy in adolescent patients

Surgical treatment of medication-resistant mesial temporal lobe epilepsy (MTLE) is associated with cognitive deficits. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for MTLE has been shown to result in superior cognitive outcomes in adults when compared to open surgical resection. However, data regarding postoperative cognitive outcomes in adolescent and pediatric patients is limited. We retrospectively reviewed sequential cases of pediatric patients who underwent MRgLITT for MTLE between 2017 and 2023. Patients who had complete preoperative and 12 month postoperative neuropsychological evaluation were analyzed for changes in the neuropsychological domains of cognition, memory, executive functioning, visual scanning, graphomotor speed, and fine motor speed/dexterity. Six adolescent patients who underwent MRgLITT for MTLE (x̄ age = 19.0 years, SD = 1.2) and had complete preoperative and postoperative neuropsychological evaluations were included in the analysis. There were no statistically significant changes across neuropsychological domains when comparing pre- and postoperative cognitive evaluations, including verbal memory scores. Clinically significant changes in phonemic fluency were observed when examining side-specific effects and improved for patients who received right-sided MRgLITT but declined for patients who received left-sided MRgLITT. 50 % of patients achieved Engel I outcome at last follow-up. Our preliminary results suggest minimal adverse neuropsychologic effects following MRgLITT for adolescent MTLE, including preservation of verbal memory. Clinical outcomes were similar with those reported in the literature.