Focus of Report: Laser interstitial thermal therapy (LITT) with real-time magnetic resonance imaging thermography is being investigated as a minimally invasive surgical alternative for treatment of mesial refractory temporal lobe epilepsy (MTLE).

Technology Description: LITT delivers thermal energy to cause cell death via protein denaturation and DNA damage with a goal to achieve selected destruction of targeted pathological tissue. A trajectory to the seizure focus sparing eloquent regions is preplanned by neuroimaging prior to LITT and monitored during the procedure.

Controversy: LITT has been used in multiple settings where the precise targeting of pathological tissue is necessary to avoid damage to normal tissue. In patients with refractory epilepsy, LITT may represent a minimally invasive surgical alternative to open surgical resection. However, evidence evaluating LITT as an option for refractory epilepsy has only started to emerge in recent years. In addition, both Food and Drug Administration–cleared devices have had product recalls for varying reasons.

Key Questions:

  • Is LITT effective for refractory MTLE in adults?

  • How does LITT compare with alternative interventions for patients with refractory MTLE?

  • Is LITT safe for the treatment of refractory MTLE, and are there long-term safety considerations?

  • Have definitive patient selection criteria been established for LITT for refractory MTLE?

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