Laser Therapy Shows Promise for Patients with Refractory Epilepsy

Hope for some people with epileptic seizures not controlled by medication comes in the form of a new minimally invasive technique called laser interstitial thermal therapy. And the University of Miami Health System’s Epilepsy Center is the only facility offering this treatment option in South Florida.

To prepare for the LiTT procedure, imaging and diagnostic tests are used to determine the location in the brain causing the seizures.

To perform laser interstitial thermal therapy (LiTT), a physician first uses imaging and diagnostic tests to determine the location of the brain causing the seizures. Then a neurosurgeon inserts a tiny fiberoptic laser (under 2mm in diameter) using real-time imaging, fires the tip of the laser to heat the target brain tissue and irreversibly destroys the area using thermal energy.

“From the data we have so far, the results are promising,” said Jonathan R. Jagid, M.D., associate professor of neurological surgery at the University of Miami Miller School of Medicine and a neurosurgeon at the University of Miami Health System. Although it’s premature to compare outcomes with traditional open brain surgery, LiTT “is less invasive, results in a much shorter hospital stay and is much better tolerated.” Physicians at the Epilepsy Center use LiTT for people with seizures originating from the temporal lobe, a common locus of epilepsy in adults.

In the LiTT procedure, a neurosurgeon inserts a tiny fiberoptic laser (under 2mm in diameter) using real-time imaging, fires the tip of the laser to heat the target brain tissue and irreversibly destroys the area using thermal energy.

Temporal lobectomy surgery requires extensive incisions, bony removal and typically a five- to six-day hospital stay. In contrast, LiTT is performed through a 3mm incision and hole in the skull, and many patients leave within 24 hours. In addition, an excessive amount of extra brain tissue often needs to be removed during traditional surgery to gain access to the deep areas of the brain responsible for seizures. A potential major advantage of LiTT is minimizing collateral damage to healthy tissue.

Preliminary data suggest that in appropriate candidates the seizure-freedom rate could be similar to that experienced by patients after more invasive open surgery, Jagid said. Speaking of candidates, physicians can refer adults with medication refractory seizures — who comprise about 30 percent of all people with epilepsy — to the epilepsy center for evaluation and further workup.

More than 30 patients have undergone LiTT at the Epilepsy Center to date. “We’re publishing results from our first 23 patients within the next month,” Jagid said. In addition, research is ongoing, and Jagid and colleagues are actively recruiting participants for a multicenter study of stereotactic laser ablation for temporal lobe epilepsy.

Tags: epilepsy, epilepsy center, jagid, laser therapy, minimally invasive, neurological surgery, seizures