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Author Notes:

Jon T. Willie, jon.t.willie@emory.edu

DLD’s research efforts are currently funded by two grants from the NIH/NINDS, which partially supported his work on this manuscript (K02NS070960 & R01NS088748); these grants provide salary support for DLD and laboratory staff, and cover the cost of data acquisition.

JTW has received research support from and/or has served as a paid consultant for Medtronic (consulting and research support), Neuropace (consulting and research support), Clearpoint/MRI Interventions (consulting), AiM Medical (consulting). REG has received research support from and/or has served as a paid consultant for Abbott (consulting and research support), Boston Scientific (consulting and research support), SanBio (consulting and research support), Voyager Therapeutics (consulting and research support), Medtronic (consulting and research support), Neuropace (consulting and research support), Zimmer Biomet (consulting). DLD has received research support from Medtronic, Inc.

The remaining authors have no conflicts of interest.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences & Neurology
  • Engel classification
  • epilepsy surgery
  • extratemporal lobe epilepsy
  • laser interstitial thermal therapy
  • low voltage fast activity
  • stereoelectroencephalography

Stereotactic MRI-guided laser interstitial thermal therapy for extratemporal lobe epilepsy

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Journal Title:



Volume 61, Number 8


, Pages 1723-1734

Type of Work:

Article | Post-print: After Peer Review


Objective: Magnetic resonance imaging (MRI)–guided laser interstitial thermal therapy (MRg-LITT) is an alternative to open epilepsy surgery. We assess safety and effectiveness of MRg-LITT for extratemporal lobe epilepsy (ETLE) in patients who are considered less favorable for open resection. Methods: We retrospectively reviewed sequential cases of patients with focal ETLE who underwent MRg-LITT between 2012 and 2019. Epileptogenic zones were determined from standard clinical and imaging data ± stereoelectroencephalography (SEEG). Standard stereotactic techniques, MRI thermometry, and a commercial laser thermal therapy system were used for ablations. Anatomic MRI was used to calculate ablation volumes. Clinical outcomes were determined longitudinally. Results: Thirty-five patients with mean epilepsy duration of 21.3 ± 12.2 years underwent MRg-LITT for focal ETLE at a mean age 36.4 ± 12.7 years. A mean 2.59 ± 1.45 trajectories per patient were used to obtain ablation volumes of 8.8 ± 7.5 cm3. Mean follow-up was 27.3 ± 19.5 months. Of 32 patients with >12 months of follow-up, 17 (53%) achieved good outcomes (Engel class I + II) of whom 14 (44%) were Engel class I. Subgroup analysis revealed better outcomes for patients with lesional ETLE than for those who were nonlesional, multifocal, or who had failed prior interventions (P =.02). Of 13 patients showing favorable seizure-onset patterns (localized low voltage fast activity or rhythmic spiking on SEEG) prior to ablation, 9 (69%) achieved good outcomes, whereas only 3 of 11 (27%) who show other slower onset patterns achieved good outcomes. Minor adverse events included six patients with transient sensorimotor neurologic deficits and four patients with asymptomatic hemorrhages along the fiber tract. Major adverse events included one patient with a brain abscess that required stereotactic drainage and one patient with persistent hypothalamic obesity. Three deaths—two seizure-associated and one suicide—were unrelated to surgical procedures. Significance: MRI-guided laser interstitial thermal therapy (or MRg-LITT) was well-tolerated and yielded good outcomes in a heterogeneous group of ETLE patients. Lesional epilepsy and favorable seizure-onset patterns on SEEG predicted higher likelihoods of success.
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