In a recent study published in Epilepsia, 80% of people treated with laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) were seizure free or almost seizure free (Engel 1 or Engel 2 classification) 2 years after the procedure.
Using retrospective image-based evlauation for consistency across a large multicenter cohort (n = 234) and quantify surgical targeting, this research showed that 58% of people treated were free of disabling seizures both at 1 and 2 years after treatment.
Ablations that included greater amygdalar volume with more anterior, medial, and inferior temporal lobe structures were more likely to be associated with seizure freedom. History of bilateral tonic-clonic seizures decreased likelihood of achieving seizure freedom.
“Surgery offers a clear benefit to patients whose epilepsy is not controlled by medication but continues to be underutilized. This study adds to the clinical evidence that demonstrates the benefit from this minimally invasive approach, which may be more attractive to patients than a standard craniotomy and surgical resection,” said Joseph Neimat, MD, chairman of the Department of Neurological Surgery at the University of Louisville School of Medicine, an investigator on the study, and member of the Practical Neurology editorial board. “Epilepsy can compromise the quality of life for many people, and my experience working with these patients is that achieving seizure freedom, or even near-freedom, can be absolutely life-changing.”
Cases evaluated includes people ages 7 to 82 years. The surgical system used for LITT (Monteris NeuroBlate System; Monteris Medical, Plymouth, MN) enables a robotic interface for precise, safe delivery of laser energy.
Unlike resective epilepsy surgery, LITT opens a small burr hole of approximately 15 mm to insert a probe, with intraoperative MRI guidance, the seizure foci for laser-generated heat ablation. The precise nature of the procedure lessens risk of harm to nearby structures.
Lee I. Kubersky, MD
James Geyer, MD, and Paul Cox