Laser interstitial thermal therapy (LITT) in patients with drug-resistant epilepsy

Laser interstitial thermal therapy (LITT) is a minimally invasive procedure that involves the use of laser light to selectively ablate lesions or brain structures. This technique is performed under real-time MRI guidance, which allows for excellent precision and predictable tissue ablation volume, thus minimizing the risk of damage to the normal brain structures. LITT is used as a treatment option for patients with drug-resistant epilepsy, and it has demonstrated effectiveness in various epilepsy subtypes. For instance, in mesial temporal lobe epilepsy, LITT has been shown to result in 50% of patients being seizure-free in the medium-term. Furthermore, LITT has been used in extratemporal epilepsies such as lesional epilepsies and hypothalamic hamartomas, with 90% of patients achieving freedom from gelastic seizures at 1 year. Additionally, LITT can be used to perform callosotomy in patients with epileptic encephalopathy, reducing severe seizures in approximately 50% of cases. The procedure has low rates of postoperative hemorrhage (<10%) and permanent complications (5%), leading to short hospitalization periods. Consequently, LITT appears to be a safe treatment option for highly selected patients and may expand the indications for surgery in patients with refractory epilepsy who cannot undergo craniotomy (deep-seated lesions or lesions located in eloquent areas) or have contraindications to the procedure.

However, a controlled randomized trial comparing LITT with open surgery is necessary to accurately position LITT within the therapeutic arsenal for managing refractory epilepsy.