DAY 1 | Minimally Invasive Laser Ablation Provides Durable Results in the Treatment of Refractory Temporal Lobe Epilepsy

Laser interstitial thermal therapy (LITT) achieved sustained reductions in seizure activity in patients with drug-resistant mesial temporal lobe epilepsy, according to an analysis featured at the 2025 American Epilepsy Society Annual Meeting, in Atlanta, Georgia.

Mesial temporal lobe epilepsy is the most common type of focal epilepsy, originating in the limbic system structures within the temporal lobe, such as the hippocampus, amygdala, and parahippocampal gyrus. LITT is a minimally invasive alternative to traditional open surgery with anterior temporal lobectomy for drug-resistant focal epilepsy. 
Adults and children with mesial temporal lobe epilepsy treated with LITT at the Stanford Medical Center from October 2014 through October 2023 were followed up for a minimum of 2 years to assess the efficacy of the procedure in this hard-to-treat population. While additional patients will continue to be followed up in the prospective study, the initial analysis included 60 patients who underwent LITT to treat temporal lobe epilepsy. 

More than half of the participants (58%) achieved freedom from disabling seizures, defined as an Engel Class I outcome, after their initial LITT procedures. Approximately one-third (35%) of the patients achieved complete seizure freedom (Engel Class IA), while 6% had only non-disabling focal aware seizures (Engel Class IB); 13% experienced some disabling seizures but were free of disabling seizures for at least 2 years (Engel Class IC), and approximately 3% had generalized convulsions with anti-seizure medication withdrawal (Engel Class ID).  
The results also showed that most participants had significant, sustained reductions in baseline seizure frequency. Moreover, approximately half of the patients had Engel Class I outcomes after subsequent LITT procedures. 

“The purpose of this study was to look at the longer-term outcomes,” lead author Jessica Falco-Walter, MD, associate professor at the Stanford University School of Medicine, explained during a poster session. “The concern is that it will not hold up compared to an anterior temporal lobectomy. But [the results] seem to hold up.” 

Falco-Walter noted that LITT, a well-tolerated procedure that is increasingly being used across the United States owing to its minimally invasive nature, is a viable first-line option that can achieve seizure reduction in carefully selected patients with drug-resistant mesial temporal lobe epilepsy. Subsequent LITT procedures and anterior temporal lobectomy may be subsequently performed in individuals with persistent seizures after initial LITT.