Laser interstitial thermal therapy for mesial temporal lobe epilepsy

Laser interstitial thermal therapy (LITT) is an increasingly standard surgical tool for ablating epileptic foci, and the Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN) registry, representing the largest prospective multicenter cohort, aimed to describe seizure outcomes, procedural outcomes, and safety data for LITT in mesial temporal lobe epilepsy (MTLE). LITT was found to be well tolerated and effective for drug-resistant MTLE, showing clinically meaningful seizure outcomes and quality of life (QOL) improvements. At two-year follow-up, 58.4% of patients achieved Engel 1 outcomes (seizure-free or non-disabling auras) and 57.2% achieved International League Against Epilepsy (ILAE) 1/2 outcomes (seizure-free or rare seizures), which are comparable to anterior temporal lobectomy (ATL) and significantly better than medical management (18.5 odds ratio for Engel 1 outcome). The procedure demonstrated significant QOL improvements at nearly all assessed time points, affecting domains like seizure worry, medication effects, and social functioning, with outcomes similar to ATL for seizure-free patients. Procedurally, LITT is considered expedient, with a median hospital stay of 1.3 days (compared to 3 days for resection), a low 90-day readmission rate of 7.7%, and minimal mean discharge head pain of 2.1 on a 0-10 scale. Adverse events occurred in 16.5% of patients, mostly mild and transient, with permanent deficits observed in 5.5% of patients, which is lower than reported for ATL. The study also noted a decrease in postoperative intensive care unit (ICU) admissions over time, suggesting increased familiarity with the procedure, and highlighted that the 14 pediatric patients in the cohort had similar outcomes to adults. Overall, these findings strongly support LITT as a safe, effective, and minimally invasive treatment option for drug-resistant MTLE.