目的:使用MRI引导的激光间质热治疗(MRgLITT)已成为耐药颞叶癫痫(TLE)患者的一种有希望的治疗选择。尽管微创方法有望成为实现癫痫发作自由的有效治疗方法,仍有必要对其对功能结果的影响进行全面审查。为了满足这一需求,这篇综述旨在总结有关MRgLITT治疗TLE后功能和神经认知结局的数据.
方法:根据PRISMA指南,由两名独立审核员筛选了四个主要电子数据库。所有与认知相关的功能数据,行为,收集和分析情绪结局,并发布神经心理学测试以评估术前和术后结局.评估的功能结果分为5个最常见的类别:言语认知,视觉认知,认知情绪,视觉缺陷,和其他高阶认知功能。
结果:共筛选了4184项研究,最终纳入14项研究中的408名患者进行分析。通过比较31种不同功能和认知评估的综合术前和术后评分来评估功能区的变化。并以状态改善的患者百分比为表格,被拒绝,或者被维护,在可能的地方。在言语(n=112)和视觉(n=42)认知中,下降的患者率为20.4%和13.5%,分别,改善率分别为24.9%和16.7%,分别。评估的其他功能结果,包括认知情绪(n=150),视力缺陷(n=325),和高阶认知过程,如注意力/处理(n=19),运动认知(n=18),和一般执行功能(n=4),表现出不同的下降速度,从10.5%到25%不等。
结论:MRgLITT是治疗TLE的一种有效的微创外科替代治疗方法,但对患者的功能和认知状态有明显的影响。这篇综述证明了需要标准化方法来准确捕获和量化MRgLITT的相关风险,以优化其对患者生活质量的影响。
OBJECTIVE: The use of MRI-guided laser interstitial thermal therapy (MRgLITT) has emerged as a promising treatment option for patients with drug-resistant temporal lobe epilepsy (TLE). Although the minimally invasive approach holds promise as an effective treatment for achieving seizure freedom, a comprehensive
review of its impact on functional outcomes is still warranted. To address this need, this
review aims to summarize data pertaining to the functional and neurocognitive outcomes following MRgLITT for TLE.
METHODS: Four primary electronic databases were screened following PRISMA guidelines by two independent reviewers. All functional data related to cognitive, behavioral, and emotional outcomes were gathered and analyzed as well as the neuropsychological tests issued to assess pre- and postoperative outcomes. The functional outcomes assessed were grouped into the 5 most common categories: verbal cognition, visual cognition, cognitive emotion, visual deficits, and other higher-order cognitive functioning.
RESULTS: A total of 4184 studies were screened and ultimately 408 patients from 14 studies were included for analysis. Changes in functional areas were assessed by comparing pre- and postoperative scores across a comprehensive set of 31 different functional and cognitive assessments, and were tabulated as the percentage of patients whose status improved, declined, or was maintained, where possible. In verbal (n = 112) and visual (n = 42) cognition, the rates of patients experiencing a decline were 20.4% and 13.5%, respectively, and the rates of improvement were 24.9% and 16.7%, respectively. Other functional outcomes assessed, including cognitive emotion (n = 150), visual deficits (n = 325), and higher-order cognitive processes like attention/processing (n = 19), motor cognition (n = 18), and general executive function (n = 4), exhibited varying rates of decline, ranging from 10.5% to 25%.
CONCLUSIONS: MRgLITT is an effective and minimally invasive surgical alternative treatment for TLE, but there is an observable impact on patient functioning and cognitive status. This
review demonstrates the need for standardized methods that can accurately capture and quantify the associated risk of MRgLITT to optimize its effect on patient quality of life moving forward.