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Review
Curative and palliative MRI-guided laser ablation for drug-resistant epilepsy
  1. Mesha-Gay Brown1,
  2. Cornelia Drees1,
  3. Lidia M Nagae1,
  4. John A Thompson2,
  5. Steven Ojemann2,
  6. Aviva Abosch2
  1. 1Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
  2. 2Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
  1. Correspondence to Dr Mesha-Gay Brown, Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA; mesha-gay.brown{at}ucdenver.edu

Abstract

Epilepsy is a common neurological disorder occurring in 3% of the US adult population. It is characterised by seizures resulting from aberrant hypersynchronous neural activity. Approximately one-third of newly diagnosed epilepsy cases fail to become seizure-free in response to antiseizure drugs. Optimal seizure control, in cases of drug-resistant epilepsy, often requires neurosurgical intervention targeting seizure foci, such as the temporal lobe. Advances in minimally invasive ablative surgical approaches have led to the development of MRI-guided laser interstitial thermal therapy (LITT). For refractory epilepsy, this surgical intervention offers many advantages over traditional approaches, including real-time lesion monitoring, reduced morbidity, and in some reports increased preservation of cognitive and language processes. We review the use of LITT for epileptic indications in the context of its application as a curative (seizure freedom) or palliative (seizure reduction) measure for both lesional and non-lesional forms of epilepsy. Furthermore, we address the use of LITT for a variety of extratemporal lobe epilepsies. Finally, we describe clinical outcomes, limitations and future applications of LITT for epilepsy.

  • epilepsy
  • epilepsy, surgery
  • neurosurgery
  • stereotaxic surgery

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Footnotes

  • Contributors M-GB, CD, LMN, JAT, SO and AA devised the framework for the review. M-GB, CD, LMN and JAT wrote the review. M-GB, CD, LMN, JAT, SO and AA edited the review.

  • Competing interests AA: Medtronic (ad hoc consulting).

  • Patient consent Obtained.

  • Provenance and peer review Commissioned; externally peer reviewed.

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