Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA.
Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
J Neurol Neurosurg Psychiatry. 2018 Apr;89(4):425-433. doi: 10.1136/jnnp-2017-316003. Epub 2017 Oct 30.
Epilepsy is a common neurological disorder occurring in 3% of the US adult population. It is characterised by seizures resulting from aberrant hypersynchronous neural activity. Approximately one-third of newly diagnosed epilepsy cases fail to become seizure-free in response to antiseizure drugs. Optimal seizure control, in cases of drug-resistant epilepsy, often requires neurosurgical intervention targeting seizure foci, such as the temporal lobe. Advances in minimally invasive ablative surgical approaches have led to the development of MRI-guided laser interstitial thermal therapy (LITT). For refractory epilepsy, this surgical intervention offers many advantages over traditional approaches, including real-time lesion monitoring, reduced morbidity, and in some reports increased preservation of cognitive and language processes. We review the use of LITT for epileptic indications in the context of its application as a curative (seizure freedom) or palliative (seizure reduction) measure for both lesional and non-lesional forms of epilepsy. Furthermore, we address the use of LITT for a variety of extratemporal lobe epilepsies. Finally, we describe clinical outcomes, limitations and future applications of LITT for epilepsy.
癫痫是一种常见的神经系统疾病，在美国成年人中发病率为 3%。其特征是由异常的超同步神经活动引起的癫痫发作。大约三分之一的新诊断癫痫病例在对抗癫痫药物的治疗下无法无癫痫发作。对于耐药性癫痫，最佳的癫痫控制通常需要针对癫痫灶的神经外科干预，如颞叶。微创消融手术方法的进步导致了磁共振引导激光间质热疗（LITT）的发展。对于难治性癫痫，与传统方法相比，这种手术干预具有许多优势，包括实时病变监测、降低发病率，并且在一些报告中增加了认知和语言过程的保留。我们在其作为致痫性（无癫痫发作）或姑息性（癫痫发作减少）措施的应用背景下，回顾了 LITT 用于癫痫适应症的情况，包括病变性和非病变性癫痫的应用。此外，我们还介绍了 LITT 用于各种颞叶外癫痫的应用。最后，我们描述了 LITT 治疗癫痫的临床结果、局限性和未来应用。
