Costs Associated with Laser Interstitial Thermal Therapy Are Lower Than Anterior Temporal Lobectomy for Treatment of Temporal Lobe Epilepsy.

BACKGROUND: Laser interstitial thermal therapy (LITT) is a minimally invasive alternative to anterior temporal lobectomy (ATL) for treatment of temporal lobe epilepsy. It has gained popularity as familiarity with technique increases and outcomes are better characterized. There has been no direct cost comparison between the 2 techniques in literature to date. The current study directly compares hospital costs associated with LITT with those of ATL patients and analyzes the factors potentially responsible for those costs. METHODS: Patients who underwent ATL (27) and LITT (15) were retrospectively reviewed for total hospital costs along with demographic, surgical, and postoperative factors potentially affecting cost. T-tests were used to compare costs and independent linear regressions, and hierarchical regressions were used to examine predictors of cost for each procedure. RESULTS: Mean hospital costs of admission for single-trajectory LITT ($104,929.88) were significantly less than for ATL ($134,980.04) (P = 0.001). In addition, length of stay, anesthesia costs, operative room costs, and postoperative hospitalization costs were all significantly lower in LITT. CONCLUSIONS: Given the minimally invasive nature of LITT, it is associated with shorter length of stay and lower hospital costs than ATL in the first head-to-head comparison of procedural costs in literature to date. Long-term efficacy as it relates to these costs associated with LITT and ATL should be further investigated to better characterize the utility of LITT in temporal lobe epilepsy patients.

[(1)H MR spectroscopy. Methods and applications in diagnosis and assessment of surgical and conservative treatment strategies in epilepsies]. / (1)H-MR-Spektroskopie. Methoden und Anwendungen in der Diagnostik und Beurteilung operativer und konservativer Therapiestrategien bei Epilepsien.

Techniques and methods of clinical (1)H-MR spectroscopy are described in this manuscript. The role of (1)H-MRS in the multimodal focus analysis of temporal lobe epilepsy (TLE) is illustrated with special respect to focus lateralization and differentiation between mesial and lateral (neocortical) TLE. Additionally the application of (1)H-MRS for evaluating postoperative outcome and monitoring conservative antiepileptic treatment schedules is summarized.

Algorithm on the clinical evaluation of epilepsy.

Epilepsy is an important public health problem because of its prevalence in the community and the economic disadvantage associated with its chronic morbidity. Uncontrolled seizures are potentially life-threatening and have adverse psychosocial consequences. Surgery is an effective but underutilized therapy for some patients with medically refractory seizures. However, this form of treatment demands precise localization of the epileptogenic zone. In recent years there have been major advances in the development of various imaging techniques for seizure localization. The best combination of diagnostic testing with regard to cost-benefit has been debated. A rational strategy for the deployment of these techniques is discussed.

Psychiatric test assessment of patients with psychomotor epilepsy.

The authors evaluated the psychiatric status of 31 patients who had temporal lobectomies and 6 patients who received implantation of depth electrodes for relief of epileptic seizures. Results showed a general postoperative improvement in overall psychopathology (measured by the Brief Psychiatric Rating Scale) and in depression in particular; however, depression tended to recur with the passage of time after lobectomy.