Purpose of the Statement

  1. To provide an evidence-based, best practices summary to guide health-care providers in the use of Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) in the management of epilepsy
  2. To report consensus opinion of the American Society for Stereotactic and Functional Neurosurgery (ASSFN) regarding the use of MRgLITT for intractable epilepsy

Importance of the American Society of Stereotactic and Functional Neurosurgery (ASSFN) Statement

  1. Stereotactic and functional neurosurgeons are domain-specific experts in the specialty literature and the practical use of stereotactic and open procedures for the surgical management of drug-resistant epilepsy (DRE).
  2. Stereotactic and functional neurosurgeons are domain-specific experts in the comparative assessment of benefits, risks, and alternatives of surgical procedures for the management of patients with DRE.

Indications for the Use of MRgLITT as a Treatment Option for Patients With DRE Include All of the Following Criteria

  1. Failure to respond to, or intolerance of, at least 2 appropriately chosen medications at appropriate doses for disabling, localization-related epilepsy AND
  2. Well-defined epileptogenic foci or critical pathways of seizure propagation accessible by MRgLITT.

Contraindication to Use of MRgLITT

  1. Inability to identify the epileptogenic focus (or foci) or critical pathways within epileptogenic networks.
  2. Inability to undergo magnetic resonance imaging (MRI) because of medical reasons.
  3.  Medical contraindications to surgery, e.g.,  unstable cardiac or respiratory conditions, anticoagulants that cannot be stopped, bleeding diatheses 

Recommendations Are Based On

  1. Safety and efficacy demonstrated in multiple peer reviewed large case series demonstrating the safety and efficacy of MRgLITT in reducing seizure frequency in patients with DRE that is nearly comparable to data obtained from cases series of open surgical procedures.
  2. Published literature demonstrates that MRgLITT is a less invasive option for many types of focal DRE that involves a shorter hospital stay and less surgical and neurologic morbidity as compared to open surgical resection for such common epilepsy etiologies as mesial temporal epilepsy, hypothalamic hamartomas, and focal cortical dysplasia/periventricular nodular heterotopia
  3. Some published studies indicate that MRgLITT may better preserve cognitive functions as compared to open epilepsy surgery
  4. When offered a choice between open surgery and MRgLITT, patients increasingly prefer LITT to open surgery and many will otherwise refuse surgical treatment at all. Moreover, MRgLITT has also become the first choice procedure of many epilepsy teams for treatment of many focal epilepsies and has essentially completely supplanted open surgery for epilepsy due to hypothalamic hamartomas. These trends make it unlikely that any randomized trials between MRgLITT and open surgery will be performed.

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