MTLE

Interstitial Thermal Therapy in Mesial Temporal Lobe Epilepsy

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In a prospective multicenter registry (LAANTERN), observational cohort Landazuri et al. from the University of Kansas Medical Center, Kansas City; Washington University, St. Louis; Duke University, Durham; University of Louisville, Nashville; Norton Health Care, Louisville; UT Southwestern, Dallas; Mount Sinai, New York; Yale, New Haven; University of Pittsburgh; UC San Diego; UAMS, Little Rock; Northwestern, Chicago; United Children’s St. Paul; Geisinger, Danville; AdventHealth, Orlando. published in JAMA Neurology to evaluate seizure outcomes, procedural safety, and QoL following laser interstitial thermal therapy in drug‑resistant mesial temporal lobe epilepsy. Over 50% of patients achieved Engel I or ILAE 1/2 seizure freedom at 2 years with mild, transient adverse events and QOL improvement in this large real‑world cohort

Critical Review

  • Strengths:
    • Largest prospective, multicenter US LITT registry for MTLE with 145 participants and extended 2‑year follow‑up
    • Rigorous real‑world data from 15 level IV epilepsy centers, with both adult and pediatric patients
    • Comprehensive data on procedural metrics (e.g., ablation volume, operating time, LOS) and seizure/QoL outcomes
  • Limitations:
    • No surgical comparator arm (e.g., open anterior temporal lobectomy), limiting comparative effectiveness assessment
    • Potential selection bias: centers specialized in LITT pathways and inclusion criteria requiring ≥6 months follow‑up
    • Heterogeneous etiology (MTS vs MRI‑negative) may mask subpopulation differences; no predictors of outcome identified
    • Median follow‑up limited to 2 years; long‑term seizure freedom and delayed complications remain unclear

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