Laser Thermal Ablation Therapy Brings Seizure Freedom to 54% of Children Treated 

A new study being presented virtually at American Epilepsy Society AES2020 showed MRI-guided laser interstitial thermal therapy (MR-LITT) in children with medically refractory epilepsy, achieved seizure freedom for 54% 1 year after the procedure. Children treated (n=182) were age 14 months of age to 21 years and received MR-LITT between 2013 and 2020. Of the 137 children who had 1 procedure and for whom 1-year seizure outcomes were available, 74 (54%) reported they no longer had seizures. 

For the laser therapy, the surgeon makes a small hole in the skull and advances a thin laser fiber to the lesion that is the source of seizures. Laser heat energy is precisely applied to burn the lesion and the temperature is carefully monitored using MRI to protect nearby brain tissue. 

For the study, 20 children had 2 procedures and 12 (60%) were seizure-free after 1  year. Neurologic deficits such as weakness or visual or sensory disturbances occurred in 15 (8%) of the children but resolved in all but 2 (1%). None of the children had major bleeding on the brain. A single child died (.5%) owing to brain swelling. 

Comparatively, studies have shown that 65% of children who have epilepsy surgery experience freedom from seizures at 1 year; 5.1% have permanent neurologic deficits; and .4% to 1.2% die, depending on the lesion location. Although children typically stay in the hospital for 2 days after MRI-guided laser therapy, the stay is about 1 week after traditional epilepsy surgery. 

“Compared to surgery, MRI-guided laser therapy can help reduce the risk of injury to critical brain structures and minimize serious neurological deficits,” said Elysa Widjaja, MD, MPH, pediatric neuroradiologist at the Hospital for Sick Children and professor, University of Toronto. “The therapy is particularly effective for lesions located deep within the brain, reaching them with minimal damage to normal brain tissue. Because it is minimally invasive, MRI-guided laser therapy is generally well-tolerated. While MRI-guided laser therapy is worth considering in children with drug-resistant epilepsy, not all are candidates for the procedure, such as those with larger lesions in the brain.”