The American Society for Stereotactic and Functional Neurosurgery released a position statement on the recommended use of MRI-guided laser interstitial therapy (MRgLITT) as first-line surgical therapy for various types of drug-resistant epilepsy (DRE).

Epilepsy will affect 1 in 26 people throughout their lifetime. Among the population with epilepsy, 25%-40% have DRE, in which 2 trials of antiepileptic drugs have failed to control seizures. Persistent seizures are associated with decreased life expectancy and significant negative impacts to quality of life.

Many patients with DRE are eligible for surgery, but only about 4% of these patients actually undergo open surgery.


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MRgLITT, a selective ablation procedure, is a less invasive treatment option compared with open surgery. A prior multi-institution study found that up to 58% of the 234 patients with DRE experienced freedom from seizures at 1 year and 77% had a significant seizure reduction. This study found that MRgLITT was a more effective treatment option than continued medical management alone.

In addition, more patients were willing to undergo MRgLITT than open surgery, indicating that MRgLITT may increase treatment access to patients suffering with persistent seizures.

Although MRgLITT is a relatively new procedure for DRE, the largest single center trial found that 62% of patients were free from seizures at an average follow-up of 43 months. A meta-analysis has predicted that efficacy of MRgLITT will likely wane over time, reducing to 42% at 36 months.

Patients who underwent MRgLITT have reported less pain and require shorter stays in the hospital following the procedure compared with open surgery. The real-time thermal monitoring during MRgLITT allows for surgeons to more effectively avoid serious neurological complications. The most commonly reported adverse effect is visual field deficit, occurring among 5%-7% of patients.

The society stated that there was sufficient evidence to recommend MRgLITT for the treatment of mesial temporal lobe epilepsy and hypothalamic hamartomas. Some success has also been reported for focal cortical dysplasias, periventricular nodular heterotopias, tuberous sclerosis, and cavernous malformations.

“While long-term outcomes must be compared against proven surgical resection techniques, MRgLITT serves as a minimally-invasive option that clearly provides greater benefit in patients with DRE than medical management alone,” the society concluded.

Reference

Wu C, Schwalb JM, Rosenow J, et al. American Society for Stereotactic and Functional Neurosurgery Position Statement on Laser Interstitial Thermal Therapy for the Treatment of Drug-Resistant Epilepsy. Accessed October 4, 2021.