Epileptologist's view: Laser interstitial thermal ablation for treatment of temporal lobe epilepsy

Abstract

A procedure called laser interstitial thermal ablation has been utilized to treat drug resistant epilepsy. With this technique, a probe is stereotactically inserted into a target structure responsible for seizures, such as mesial temporal lobe, hypothalamic hamartoma, or a small malformation of cortical development, and the tip is then heated by application of laser energy to ablate structures adjacent to the probe tip. This procedure has the advantage of selectively targeting small lesions responsible for seizures, and is far less invasive than open surgery with shorter hospitalization, less pain, and rapid return to normal activities. Initial results in mesial temporal lobe epilepsy are promising, with perhaps half of patients becoming free of seizures after the procedure. Neuropsychological deficits appear to be reduced because of the smaller volume of ablated cortex in contrast to large resections. More research must be done to establish optimal targeting of structures for ablation and selection of candidates for surgery, and more patients must be studied to better establish efficacy and adverse effect rates.

Keywords: Drug resistant epilepsy; Epilepsy surgery; Laser ablation; Magnetic resonance-guided laser interstitial thermal therapy; Medically refractory epilepsy; Mesial temporal sclerosis; Seizure; Selective amygdalohippocampectomy; Temporal lobe epilepsy; Temporal lobectomy.