A multicenter registry study found that laser interstitial thermal therapy helped more than half of patients with drug-resistant mesial temporal lobe epilepsy achieve seizure control 2 years after treatment.
The therapy was associated with brief hospital stays, low postoperative pain, and improved quality of life.
The study followed 145 patients treated with laser interstitial thermal therapy (LITT) across 15 epilepsy centers in the U.S. Of these, 77 had reached the 2-year follow-up at the time of analysis. At 2 years, 58.4% (45 of 77) achieved Engel class I outcomes—defined as seizure freedom—and 57.2% (44 of 77) met International League Against Epilepsy 1/2 criteria.
Participants included adults and 14 pediatric patients (under age 22). The mean age at LITT was 39.2 years (standard deviation [SD], 15.4), and the mean age of seizure onset was 20.4 years (SD, 13.6). Most had failed at least three antiseizure medications prior to surgery.
The minimally invasive procedure had a mean duration of 4.33 hours (SD, 2.1) with a mean blood loss of 22.0 mL (SD, 23.1). The median hospital stay was 1.3 days, and 96.6% of patients were discharged home. The mean discharge pain score was 2.1 on a 10-point scale.
Adverse events occurred in 16.5% (24 of 145) of patients, with most events categorized as mild or moderate. Three severe events were reported, including pulmonary embolism and cerebral infarction. One death due to multiorgan failure followed a postoperative embolism. Permanent neurological deficits occurred in 5.5% of patients.
By 24 months, 34.9% of patients had reduced or discontinued antiseizure medications. Quality of life, assessed using the 31-Item Quality of Life in Epilepsy Inventory, improved across nearly all domains, especially among patients who were seizure-free. Notable gains were observed in seizure worry, medication effects, and social functioning.
Pediatric outcomes were comparable to those in adults. Among the six pediatric patients with 2-year follow-up, 50% (3 of 6) achieved seizure freedom. Quality of life scores in children did not show overall improvement, but seizure worry and social functioning improved numerically.
No clinical or demographic factors—including seizure type, race, or presence of mesial temporal sclerosis—were significantly associated with seizure outcomes. However, longer duration of epilepsy before surgery was linked to greater improvements in quality of life.
The authors, led by Patrick Landazuri, MD, of the Department of Neurology at the University of Kansas Medical Center, noted that “LITT was found to be well tolerated with clinically meaningful seizure outcomes and QOL improvements.”
The study also compared seizure outcomes to those from a historical cohort receiving medical therapy. At one year, patients treated with LITT were significantly more likely to be seizure-free, with an odds ratio of 18.5 (95% confidence interval, 5.6–59.5).
The rate of sudden unexpected death in epilepsy was 5.48 per 1,000 person-years, based on two events across 365.22 person-years of follow-up.
These findings provide multicenter evidence that LITT is a safe and effective treatment for drug-resistant mesial temporal lobe epilepsy, with seizure outcomes similar to open surgery and added benefits in recovery and quality of life.
Full disclosures can be found in the published study.
Source: JAMA Neurology