OBJECTIVES: For a subset of patients with drug-resistant focal epilepsy, surgery offer a substantial chance for seizure freedom. Laser interstitial thermal therapy (LITT) is a minimally invasive approach for tissue ablation using thermotherapy, but may offer a lower chance of seizure freedom. The objective was to quantify the minimum chance of seizure freedom with LITT that patients would accept to avoid open brain surgery.

METHODS: A discrete-choice-experiment (DCE) survey was developed in consultation with patient advisors and refined using single-patient interviews. The survey included 20 blocks of 8 DCE choice questions representing continued medical management, open brain surgery and LITT, constructed using the following features: seizure freedom for at least two years (20%-70%), risk of 30-day mortality (0%-10%), and risk of neurologic deficits (0%-40%). Medical management offered no chance of seizure freedom or risks. Respondents’ treatment choices were analyzed using a random-parameters logit model. Survey participants with refractory epilepsy were recruited from a commercial panel and an academic medical center.

RESULTS: A total of 406 respondents completed the DCE survey (106 from Duke and 300 from the panel). Duke respondents took twice as much time to complete the survey. Findings using mean preference weights pooled across both cohorts indicated a willingness to consider a surgical intervention and to accept a reduction in the chance of seizure freedom from 70% to a minimum of 23% if they could undergo LITT rather than open brain surgery. For a reduction in 30-day mortality from 1% to 0% and a reduction in risk of long-term deficits from 10% to 0%, the minimum-acceptable chances of seizure freedom were 52% and 39%, respectively.

CONCLUSIONS: Patients with drug-resistant focal epilepsy who are receptive to surgical interventions would, on average, accept significantly lower treatment effectiveness to undergo a minimally invasive procedure relative to open brain surgery.