MRI-guided laser therapy effective in drug resistant epilepsy


By Michael Woodhead

8 Dec 2020

More than half of children with drug resistant epilepsy were seizure-free a year after undergoing minimally invasive laser therapy, according to data from North American neurologists.

At the American Epilepsy Society AES2020 virtual meeting, researchers reported on outcomes of 129 children ages 14 months to 21 years old who received MRI-guided laser interstitial thermal therapy (MRgLITT ) between 2013 and 2020.

MRgLITT is a novel  alternative option for epilepsy surgery approved for use in the US since 2007. It is an ablative stereotactic laser ablation  procedure used in cases of drug-resitant epilepsy where that the epileptogenic foci are localised and/or deep-seated such as in the mesial temporal lobe epilepsy and hypothalamic hamartoma.

At AES 2020 neurologists presented data from the PEP-LITT registry, which evaluated outcomes of children treated with MRgLITT from six US and two Canadian paediatric epilepsy surgery centres.

The mean age at seizure onset was 4.6 years and age at MRgLITT was 10.7 years, with children treated with a mean of 1.9 antiepileptic drugs.

Abnormal MRI findings were present in 86% patients, with hypothalamic hamartoma being the most common lesion (n=33), followed by focal cortical dysplasia (n=23).

For 93 patients in whom one-year seizure outcome was available, seizure freedom was reported in 52 (56%).

Study author Associate Professor Elysa Widjaja, paediatric neuroradiologist at the Hospital for Sick Children, Toronto, said that compared to surgery, MRI-guided laser therapy could help reduce the risk of injury to critical brain structures and minimise serious neurological deficits.

“The therapy is particularly effective for lesions located deep within the brain, reaching them with minimal damage to normal brain tissue,”  she said.

Complications relating to MRgLITT occurred in 22% of patients, including transient neurologic deficits (12%) and two cases of permanent neurologic deficits. There was no major intracranial haemorrhage. The 30-day mortality post MRgLITT was reported in one patient.

The mean length of hospital stay was 3.2 days, with a median of one day hospital stay, which compares to about one week with open surgery.

Twelve (9%) patients had more than one MRgLITT procedure, and seven of these achieved seizure freedom.

Associate Professor Widjaja noted that comparatively, studies showed that 65% of children who had open surgery experienced seizure freedom at one year, 5.1% had permanent neurological deficits and mortality rates ranged from 0.4% to 1.2%, depending on the location of the lesion being removed.

“The PEP-LITT registry will provide data for future analysis comparing seizure and health-related quality of life outcomes of MRgLITT to resective epilepsy surgery. Understanding the benefits and risks of MRgLITT will assist with decision making process on treatment options,” the authors concluded.

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