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Multicenter Study
. 2025 Sep 1;82(9):915-924.
doi: 10.1001/jamaneurol.2025.1897.

Interstitial Thermal Therapy in Mesial Temporal Lobe Epilepsy

Patrick Landazuri  1 , Jennifer J Cheng  2 , Eric Leuthardt  3 , Albert H Kim  3 , Derek G Southwell  4 , Peter E Fecci  4 , Joseph Neimat  5 , David Sun  6 , Bradley Lega  7 , Fedor Panov  8 , Veronica Chiang  9 , Taylor Abel  10 , Sharona Ben-Haim  11 , David E Piccioni  12 , Jerry J Shih  12 , Viktoras Palys  13 , Analiz Rodriguez  13 , S Kathleen Bandt  14 , Joseph Petronio  15 , Michel Lacroix  16 , James Baumgartner  17
Affiliations
Multicenter Study

Interstitial Thermal Therapy in Mesial Temporal Lobe Epilepsy

Patrick Landazuri et al. JAMA Neurol. .

Abstract

Importance: Laser interstitial thermal therapy (LITT) is a surgical tool used to ablate epileptic foci and brain tumors. Understanding clinical and procedural outcomes of LITT for mesial temporal lobe epilepsy (MTLE) is relevant to clinicians and patients.

Objective: To describe seizure outcomes, procedural outcomes, and safety data of MTLE LITT.

Design, setting, and participants: Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN) is a prospective multicenter registry with up to 5 years of follow-up lasting from October 2015 to March 2023 at LAANTERN epilepsy sites, which are all level IV National Association of Epilepsy Centers in the US. Adult and pediatric LAANTERN enrollees undergoing LITT for drug-resistant MTLE with at least 6 months of follow-up were included. Those with epilepsy related to a malignant lesion were excluded.

Intervention: LITT for drug-resistant MTLE.

Main outcomes and measures: Demographic, epilepsy, and seizure characteristics; procedural data; postsurgical seizure outcomes; safety data; and quality of life (QOL) scores were prospectively collected.

Results: Fifteen centers enrolled 145 patients (73 [50.3%] female) with MTLE undergoing LITT, with 77 reaching 2-year follow-up. The mean (SD) age was 39.2 (15.4) years at time of LITT with 14 of 145 in the pediatric range (younger than 22 years). The 2 most common etiologies were mesial temporal sclerosis (n = 74) and unknown etiology or magnetic resonance imaging normal (n = 31). Mean (SD) ablation volume was 28.2 (29.8) mL. Mean (SD) surgery duration was 4.3 (2.1) hours, and mean (SD) blood loss was 22 (17.6) mL. Median (IQR) length of stay was 1 (1-3) day, and 33 patients (23%) had no intensive care unit stay postprocedure. Median (IQR) intensive care unit time was 22 (19.2-28.8) hours. Mean (SD) discharge head pain score was 2.1 (2.6) on a 0-10 scale. Most patients (n = 140 [96.6%]) were discharged home. Two-year seizure outcomes were 45 of 77 (58.4%) and 44 of 77 (57.2%) for Engel 1 and International League Against Epilepsy 1/2, respectively. No clinical characteristics were associated with seizure outcome. Adverse events were seen in 24 patients (16.5%), most being mild and transient. Pediatric seizure outcomes were similar to adult outcomes. One-third of patients stopped or decreased their antiseizure medicines. Improvements in QOL scores were seen at almost all time points assessed.

Conclusions: In the largest prospective multicenter MTLE LITT cohort, LITT was found to be well tolerated with clinically meaningful seizure outcomes and QOL improvements. These findings indicate that LITT may be considered as a treatment option for drug-resistant MTLE.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Landazuri reported serving on the medical advisory board for NeuroPace outside the submitted work. Dr Leuthardt reported personal fees from Monteris Medical during the conduct of the study. Dr Kim reported consulting fees from Monteric Medical during the conduct of the study as well as grants from Stryker for a study regarding dural substitute outside the submitted work. Dr Southwell reported grants from Neurona Therapeutics outside the submitted work. Dr Fecci reported consulting fees from Monteris Medical outside the submitted work. Dr Neimat reported consulting fees from Monteris Medical outside the submitted work. Dr Sun reported personal fees from Monteris Medical outside the submitted work. Dr Lega reported consulting fees from the National Institute on Aging outside the submitted work. Dr Chiang reported consulting fees from Monteris Medical outside the submitted work. Dr Ben-Haim reported serving on the advisory board for Boston Scientific outside the submitted work and is on the scientific advisory board of Cortisci. Dr Rodriguez reported personal fees from Monteris Medical outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Post–Laser Interstitial Thermal Therapy Seizure Outcome Data
ILAE indicates International League Against Epilepsy. aWiebe et al.
Figure 2.
Figure 2.. Median 31-Item Quality of Life in Epilepsy Inventory (QOLIE-31) Scores Post–Laser Interstitial Thermal Therapy
See this image and copyright information in PMC

References

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