, Volume 14, Issue 1, pp 176–181 | Cite as

Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy

Current Perspectives


Surgery is the most effective treatment for drug-resistant epilepsy. Long-term studies demonstrate that about 60% to 80% of patients become seizure-free after anterior temporal lobectomy and a majority of patients (about 95%) report significant seizure reduction after surgery. In the last few years, there has been significant advances in minimally invasive surgical techniques to treat drug-resistant epilepsy. These minimally invasive procedures have significant advantages over open surgery in that they produce less immediate discomfort and disability, while allowing for greater preservation of functional tissue. Laser interstitial thermal therapy (LiTT) is an example of such a procedure. Recent advances in imaging, surgical navigation, and real-time thermal monitoring have made LiTT safer and easier to implement, offering an effective and powerful neurosurgical tool for drug-resistant epilepsy. This article will review the technical considerations, uses, and potential future directions for LiTT in drug-resistant epilepsy.

Key Words

Laser interstitial thermal therapy drug-resistant epilepsy epilepsy temporal lobe epilepsy mesial temporal sclerosis temporal lobectomy. 

Supplementary material

13311_2016_498_MOESM1_ESM.pdf (1.2 mb)
ESM 1(PDF 1224 kb)


  1. 1.
    Jethwa PR, Barrese JC, Gowda A, et al. Magnetic resonance thermometry-guided laser induced thermal therapy for intracranial neoplasms: initial experience. Neurosurgery 2012; 71:133-144.CrossRefPubMedGoogle Scholar
  2. 2.
    Peavy GM. Laser and laser-tissue interaction. Vet Clinic North Am Small Animal Pract 2002; 32: 517-534.CrossRefGoogle Scholar
  3. 3.
    Franck P, Henderson P, Rothaus KO. Basics of lasers history physics and clinical applications. Clin Plast Surg 2016; 43:505-513.CrossRefPubMedGoogle Scholar
  4. 4.
    Knavel EM, Brace CL. Tumor ablation: common modalities and general practice. Tech Vasc Interv Radiol 2013; 16: 192-200CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jolesz FA, Bleier AR, Jakab P, et al. MR imaging of laser-tissue interactions. Radiology 1988;168:249-253CrossRefPubMedGoogle Scholar
  6. 6.
    Janda P, Sroka R, Mundweil B, et al. Comparison of thermal tissue effects induced by contact application of fiber guided laser systems. Laser Surg Med 2003;33:93-101CrossRefGoogle Scholar
  7. 7.
    Kang JY, Wu C, Tracy J, et al. Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy. Epilepsia 2016; 57:325-334.CrossRefPubMedGoogle Scholar
  8. 8.
    Atsina KB, Sharan AD, Wu C, et al. Longitudinal qualitative characterization of MRI features after laser interstitial thermal therapy in drug resistant epilepsy. Am J Roentgenol. 2016; 22:1-9.Google Scholar
  9. 9.
    Schwabe B, Khan T, Harth T, et al. Laser induced thermal lesions in the human brain: short-and long-term appearance on MRI. J Computer Asst Tomogr 1997; 21: 818-825.CrossRefGoogle Scholar
  10. 10.
    Medvid R, Ruiz A, Komotor RJ, et al. Current applications of MRI-guided laser interstitial thermal therapy in the treatment of brain neoplasms and epilepsy: a radiologic and neurosurgical overview. AJNR Am J Neuroradiol 2015;36: 1998-2006.CrossRefPubMedGoogle Scholar
  11. 11.
    Schober R, Bettag M, Sabel M, et al. Fine structure of zonal changes in experiemental Nd:YAG laser induced interstitial hyperthermia. Lasers Surg Med 1993:13:234-241.CrossRefPubMedGoogle Scholar
  12. 12.
    Curry DJ, Gowda A, McNichols RJ, et al. MR-guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav 2012; 24:408-414.CrossRefPubMedGoogle Scholar
  13. 13.
    Esquenazi Y, Kalamangalam GP, Slater JP, et al. Stereotatic laser ablation of epileptogenic periventricular nodular heterotopia. Epilepsy Res 2014; 108: 547-554.CrossRefPubMedGoogle Scholar
  14. 14.
    Lewis EC, Wells AG, Duchowny M, et al. MR-guided laser interstitial thermal therapy for pediatric drug resistant lesional epilepsy. Epilepsia 2015;56:1590-1598.CrossRefPubMedGoogle Scholar
  15. 15.
    Hawasli A, Bandt S, Hogan R, et al. Laser ablation as a treatment strategy for medically refractory dominant insular epilepsy: therapeutic and functional considerations. Stereotact Funct Neurosurg 2014; 92:397-404.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Waseem H, Osborn KE, Schoenberg M, et al. Laser ablation therapy: an alternative treatment for medically resistant mesial epilepsy after age 50. Epilepsy Behav 2015; 51: 152-157.CrossRefPubMedGoogle Scholar
  17. 17.
    Willie JT, Laxpati NG, Drane DL, et al. Real-time magnetic resonance guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery 2014; 74: 569-584.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Gross R, Mahmoudi B, Riley J, et al. Less is more: a novel less-invasive surgical techniques for mesial temporal lobe epilepsy that minimize cognitive impairment. Curr Opin Neurol 2015; 28: 182-191.CrossRefPubMedGoogle Scholar
  19. 19.
    Gross R, Willie J, Helmers S, et al. Stereotatic laser amygdalohippocampotomy for mesial temporal lobe epilepsy: collective experience from seven single-center, prospective, investigator initiated studies. Presented at the American Epilepsy Society Conference; December 2014; Seattle.Google Scholar
  20. 20.
    Engel J (2013) Non-pharamcological therapy of seizures. Seizures and epilepsy (pp. 603-636). New York: Oxford University Press.Google Scholar
  21. 21.
    Wiebe S, Blume WT, Girvin JP, et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med 2001;345:311-318.CrossRefPubMedGoogle Scholar
  22. 22.
    Mittal S, Montes JL, Farmer JP, et al. Long-term outcome after surgical treatment of temporal lobe epilepsy in children. J Neurosurg.2005;193:401-412.Google Scholar
  23. 23.
    Kelemen A, Barsi P, Eross L, et al. Long-term outcome after temporal lobe surgery- prediction of late worsening of seizure control. Seizure 2005;15:49-55.CrossRefPubMedGoogle Scholar
  24. 24.
    Elsharkawy AE, Alabbasi AH, Pannek H, et al. Long-term outcome after temporal lobe epilepsy surgery in 434 consecutive adult patients. J Neurosurg 2009:110:1135-1146.CrossRefPubMedGoogle Scholar
  25. 25.
    Drane DL, Loring DW, Voets NL et al. Better object recognition and naming outcome with MRI guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy. Epilepsia 2015; 56: 101-113.CrossRefPubMedGoogle Scholar
  26. 26.
    Ives-Deliperi VL, Butler JT. Naming outcome of anterior temporal lobectomy in epilepsy patients: a systematic review of the literature. Epilepsy Behav 2012; 24: 194-198.CrossRefPubMedGoogle Scholar
  27. 27.
    Abel TJ, Rhome AE, Nourski KV, et al. Direct physiologic evidence of heteromodal convergence region for proper naming in human left anterior temporal lobe. J Neurosci 2015;35: 1513-1520.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Tanriverdi T, Dudley R, Hasan A, et al. Memory outcome after temporal lobe epilepsy surgery: corticoamygdalohippocampectomy versus selective amygdalohippocampectomy. J Neurosurg 2010; 113: 1164-1175.CrossRefPubMedGoogle Scholar
  29. 29.
    Saling MM. Verbal memory in mesial temporal lobe epilepsy: beyond material specificity. Brain 2009; 132:570-582.CrossRefPubMedGoogle Scholar
  30. 30.
    Attiah M, Paulo D, Danish S, et al. Anterior temporal lobectomy compared with laser thermal hippocampectomy for mesial temporal epilepsy: a threshold analysis. Epilepsy Res 2015; 115:1-7.CrossRefPubMedGoogle Scholar
  31. 31.
    Pruitt R, Gambel A, Black K, et al. Complication avoidance in laser interstitial thermal therapy lessons learned. J Neurosurg 2016; 3: 1-8.CrossRefGoogle Scholar
  32. 32.
    Rolston JD, Chang EF. Stereotactic laser ablation for hypothalamic hamartoma. Neurosurg Clin North Am 2016; 27: 59-67.CrossRefGoogle Scholar
  33. 33.
    Wilfong A, Curry DJ. Hypothalamic hamartomas: optimal approach to clinical evaluation and diagnosis. Epilepsia 2013; 54: 109-114.CrossRefPubMedGoogle Scholar
  34. 34.
    Brandmeir N, Achara V, Sather M. Robot assisted stereotactic laser ablation for radiosurgery resistant hypothalamic hamartoma. Cureus 2016; 8: 6-10Google Scholar
  35. 35.
    Ellis JA, Mejia Munne JC, Wang SH, et al. Staged laser interstitial thermal therapy and topectomy for complete obliteration for focal cortical dysplasia. J Clin Neurosci 2016; 31: 224-228.CrossRefPubMedGoogle Scholar
  36. 36.
    Ho A, Miller KJ, Cartmell S et al. Stereotactic laser ablation of the splenium for intractable epilepsy. Epilepsy Behav Case Rep 2016; 5: 23-26.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Drane D, Willie J, Loring D, et al. Cognitive outcome of patients undergoing stereotactic laser ablation of cavernous malformation to control chronic seizures. Presented at the American Epilepsy Society Conference; December 2014; Seattle.Google Scholar
  38. 38.
    Monteith S, Snell J, Eames M, et al. Transcranial magnetic resonance-guided focused ultrasound for temporal lobe epilepsy: a laboratory feasibility study. J Neurosurg 2016; 12: 1-8.Google Scholar

Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2016

Authors and Affiliations

  1. 1.Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Thomas Jefferson University HospitalPhiladelphiaUSA

Personalised recommendations