LAUSR

OBJECTIVES To study the incidence of sudden unexpected death in epilepsy (SUDEP) after laser interstitial thermal therapy (LITT) for drug-resistant epilepsy (DRE). METHODS Prospective observational study of consecutive patients treated with LITT between 2013-2021. The primary outcome was the occurrence of SUDEP during post-operative follow-up. Surgical outcome was classified according to the Engel scale. RESULTS There were 5 deaths including 4 SUDEP among 135 patients with a median follow-up duration of 3.5 (range 0.1-9.0) years and a total of 501.3 person-years at risk. The estimated incidence of SUDEP was 8.0 (95% CI 2.2-20.4) per 1000 person-years. Three SUDEP deaths occurred in patients with poor seizure outcomes, whereas 1 patient was seizure-free. Compared to pooled historical data, SUDEP occurred at a higher rate than in cohorts treated with resective surgery and similar to non-surgical controls. DISCUSSION SUDEP occurred early and late after mesial temporal LITT. The SUDEP rate was comparable to rates reported in epilepsy surgery candidates who did not receive intervention. These findings reinforce targeting seizure freedom to decrease SUDEP risk, including early consideration for further intervention. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that LITT is not effective in reducing SUDEP incidence in patients with DRE.