Safety and short-term clinical outcomes of magnetic resonance-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy_Journal of Epilepsy

Authors：

YAO Yuan , WANG Xiu , MO Jiajie , HU Wenhan , ZHANG Chao ,  ZHANG Kai

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China;

Corresponding author：

ZHANG Kai, Email: zhangkai62035@163.com

Keywords：

Magnetic resonance-guided laser interstitial thermal therapy; Mesial temporal lobe epilepsy; Drug-resistant epilepsy

DOI：

10.7507/2096-0247.202508008

Video：

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Objective To evaluate the clinical efficacy and safety of magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) for mesial temporal lobe epilepsy (MTLE), and to compare its outcomes with anterior temporal lobectomy (ATL). Methods A retrospective cohort of 120 MTLE patients treated at Beijing Tiantan Hospital between August 2022 and August 2024 was analyzed, including 31 patients who underwent MRgLITT and 89 patients who underwent ATL. All patients received comprehensive presurgical evaluations, and stereoelectroencephalography (SEEG) was performed in selected cases. Clinical outcomes at 1 year were compared between the two groups, including seizure control (Engel classification, seizure reduction rate), cognitive and memory changes, quality of life, and postoperative complications. Results Baseline characteristics were comparable between groups. At 1-year follow-up, Engel class I outcomes were achieved in 71.0% of patients in the MRgLITT group and 67.4% in the ATL group. Seizure reduction rates were (89.6 ± 26.2)% for MRgLITT and (87.0 ± 28.7)% for ATL, with no significant difference (P=0.92). Postoperative changes in memory, cognition, and quality of life were not significantly different between groups (all P>0.05). The incidence of complications was low and similar between MRgLITT and ATL, including hemorrhage (3.2% vs. 2.2%), infection (16.1% vs. 19.1%), and neurological deficits (3.2% vs. 2.2%). Conclusion MRgLITT provides seizure control and safety outcomes comparable to ATL when applied to carefully selected MTLE patients, with the added advantages of minimal invasiveness and faster recovery. For patients with well-localized epileptogenic foci and hippocampal sclerosis, MRgLITT represents an important alternative to open resection.

Citation： YAO Yuan, WANG Xiu, MO Jiajie, HU Wenhan, ZHANG Chao, ZHANG Kai. Safety and short-term clinical outcomes of magnetic resonance-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy. Journal of Epilepsy, 2025, 11(5): 390-395. doi: 10.7507/2096-0247.202508008 Copy

1.	Jokeit H, Schacher M, Huber D, et al. Double dissociation of parahippocampal and amygdalar fmri activation in patients with mesial temporal lobe epilepsy. 2004, 56(2): 365-369.
2.	Coan A, Morita M, Campos B, et al. Amygdala enlargement occurs in patients with mesial temporal lobe epilepsy and hippocampal sclerosis with early epilepsy onset. Epilepsy & Behavior, 2013, 29: 390-394.
3.	Striano P, Nobile C. Whole-exome sequencing to disentangle the complex genetics of hippocampal sclerosis–temporal lobe epilepsy. Neurology, 2018, 4: 112-116.
4.	Morita M, Cendes F. Quantitative MRI techniques in MTLE: toward a better understanding of hippocampal sclerosis. Epilepsia, 2010, 51(3): 421-428.
5.	Hu W H, Zhang C, Zhang K, et al. Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies. Journal of Neurosurgery, 2013, 119(5): 1089-1097.
6.	Mansouri A, Fallah A, McAndrews M P, et al. Neurocognitive and seizure outcomes of selective amygdalohippocampectomy versus anterior temporal lobectomy for mesial temporal lobe epilepsy. Epilepsy Research and Treatment, 2014, 2014(1): 306382.
7.	Dorfer C, Czech T, Aull-Watschinger S, et al. Mesial temporal lobe epilepsy: long-term seizure outcome of patients primarily treated with transsylvian selective amygdalohippocampectomy. Journal of Neurosurgery, 2018, 129(1): 174-181.
8.	Pruckner P, Nenning KH, Fischmeister FPS, et al. Visual outcomes after anterior temporal lobectomy and transsylvian selective amygdalohippocampectomy: A quantitative comparison of clinical and diffusion data. Epilepsia, 2023, 64(3): 705-717.
9.	Nascimento FA, Gatto L M, Silvado C, et al. Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy. Arquivos De Neuro-Psiquiatria, 2016, 74(1): 35-43.
10.	Mansouri A, Fallah A, McAndrews MP, et al. Neurocognitive and seizure outcomes of selective amygdalohippocampectomy versus anterior temporal lobectomy for mesial temporal lobe epilepsy. Epilepsy Research and Treatment, 2014, 2014: 306382.
11.	North RY, Raskin JS, Curry DJ. MRI-guided laser interstitial thermal therapy for epilepsy. Neurosurgery Clinics of North America, 2017, 28(4): 545-557.
12.	Wicks RT, Jermakowicz WJ, Jagid JR, et al. Laser interstitial thermal therapy for mesial temporal lobe epilepsy. Neurosurgery, 2016, 79(Suppl 1): S83-S91.
13.	Le S, Ho A L, Fisher R S, et al. Laser interstitial thermal therapy (LITT): seizure outcomes for refractory mesial temporal lobe epilepsy. Epilepsy & Behavior, 2018, 89: 37-41.
14.	胡文瀚, 柏建军, 周文静, 等. 磁共振引导下激光间质热疗术治疗药物难治性癫痫的操作规范. 癫痫杂志, 2023, 9(1): 1-4.
15.	Chen JS, Lamoureux AA, Shlobin NA, et al. Magnetic resonance-guided laser interstitial thermal therapy for drug-resistant epilepsy: a systematic review and individual participant data meta-analysis. Epilepsia, 2023, 64(8): 1957-1974.
16.	Hect JL, Alattar AA, Harford EE, et al. Stereotactic laser interstitial thermal therapy for the treatment of pediatric drug-resistant epilepsy: indications, techniques, and safety. Child’s Nervous System, 2022, 38(5): 961-970.
17.	Nielsen SH, Rasmussen R. MR-guided laser interstitial thermal therapy in the treatment of brain tumors and epilepsy. Acta Neurochirurgica, 2024, 166(1): 344.
18.	Ekman FR, Bjellvi J, Ljunggren S, et al. Laser interstitial thermal therapy versus open surgery for mesial temporal lobe epilepsy: a systematic review and meta-analysis. World Neurosurgery, 2024, 192: 224-235.
19.	Yin D, Thompson JA, Drees C, et al. Optic radiation tractography and visual field deficits in laser interstitial thermal therapy for amygdalohippocampectomy in patients with mesial temporal lobe epilepsy. Stereotactic and Functional Neurosurgery, 2017, 95(2): 107-113.

1. Jokeit H, Schacher M, Huber D, et al. Double dissociation of parahippocampal and amygdalar fmri activation in patients with mesial temporal lobe epilepsy. 2004, 56(2): 365-369.
2. Coan A, Morita M, Campos B, et al. Amygdala enlargement occurs in patients with mesial temporal lobe epilepsy and hippocampal sclerosis with early epilepsy onset. Epilepsy & Behavior, 2013, 29: 390-394.
3. Striano P, Nobile C. Whole-exome sequencing to disentangle the complex genetics of hippocampal sclerosis–temporal lobe epilepsy. Neurology, 2018, 4: 112-116.
4. Morita M, Cendes F. Quantitative MRI techniques in MTLE: toward a better understanding of hippocampal sclerosis. Epilepsia, 2010, 51(3): 421-428.
5. Hu W H, Zhang C, Zhang K, et al. Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies. Journal of Neurosurgery, 2013, 119(5): 1089-1097.
6. Mansouri A, Fallah A, McAndrews M P, et al. Neurocognitive and seizure outcomes of selective amygdalohippocampectomy versus anterior temporal lobectomy for mesial temporal lobe epilepsy. Epilepsy Research and Treatment, 2014, 2014(1): 306382.
7. Dorfer C, Czech T, Aull-Watschinger S, et al. Mesial temporal lobe epilepsy: long-term seizure outcome of patients primarily treated with transsylvian selective amygdalohippocampectomy. Journal of Neurosurgery, 2018, 129(1): 174-181.
8. Pruckner P, Nenning KH, Fischmeister FPS, et al. Visual outcomes after anterior temporal lobectomy and transsylvian selective amygdalohippocampectomy: A quantitative comparison of clinical and diffusion data. Epilepsia, 2023, 64(3): 705-717.
9. Nascimento FA, Gatto L M, Silvado C, et al. Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy. Arquivos De Neuro-Psiquiatria, 2016, 74(1): 35-43.
10. Mansouri A, Fallah A, McAndrews MP, et al. Neurocognitive and seizure outcomes of selective amygdalohippocampectomy versus anterior temporal lobectomy for mesial temporal lobe epilepsy. Epilepsy Research and Treatment, 2014, 2014: 306382.
11. North RY, Raskin JS, Curry DJ. MRI-guided laser interstitial thermal therapy for epilepsy. Neurosurgery Clinics of North America, 2017, 28(4): 545-557.
12. Wicks RT, Jermakowicz WJ, Jagid JR, et al. Laser interstitial thermal therapy for mesial temporal lobe epilepsy. Neurosurgery, 2016, 79(Suppl 1): S83-S91.
13. Le S, Ho A L, Fisher R S, et al. Laser interstitial thermal therapy (LITT): seizure outcomes for refractory mesial temporal lobe epilepsy. Epilepsy & Behavior, 2018, 89: 37-41.
14. 胡文瀚, 柏建军, 周文静, 等. 磁共振引导下激光间质热疗术治疗药物难治性癫痫的操作规范. 癫痫杂志, 2023, 9(1): 1-4.
15. Chen JS, Lamoureux AA, Shlobin NA, et al. Magnetic resonance-guided laser interstitial thermal therapy for drug-resistant epilepsy: a systematic review and individual participant data meta-analysis. Epilepsia, 2023, 64(8): 1957-1974.
16. Hect JL, Alattar AA, Harford EE, et al. Stereotactic laser interstitial thermal therapy for the treatment of pediatric drug-resistant epilepsy: indications, techniques, and safety. Child’s Nervous System, 2022, 38(5): 961-970.
17. Nielsen SH, Rasmussen R. MR-guided laser interstitial thermal therapy in the treatment of brain tumors and epilepsy. Acta Neurochirurgica, 2024, 166(1): 344.
18. Ekman FR, Bjellvi J, Ljunggren S, et al. Laser interstitial thermal therapy versus open surgery for mesial temporal lobe epilepsy: a systematic review and meta-analysis. World Neurosurgery, 2024, 192: 224-235.
19. Yin D, Thompson JA, Drees C, et al. Optic radiation tractography and visual field deficits in laser interstitial thermal therapy for amygdalohippocampectomy in patients with mesial temporal lobe epilepsy. Stereotactic and Functional Neurosurgery, 2017, 95(2): 107-113.

Journal of Epilepsy

Safety and short-term clinical outcomes of magnetic resonance-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy

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