What is laser ablation?
Laser ablation (also called laser interstitial thermal therapy or LITT) is a procedure that involves using laser technology to burn the specific area in the brain that is causing seizures. This is a minimally invasive technique that is used worldwide to treat focal epilepsy in carefully selected patients.
Who requires laser ablation?
Your child’s health-care team may recommend laser ablation in the following cases:
- Seizures are not controlled by two or more anti-seizure medications.
- Based on the pre-surgical investigations (e.g., MRI, EEG, MEG and/or PET scans), the epilepsy appears to be focal, which means it is coming from a single known area (focus) in the brain.
- The area of the brain that is generating seizures either cannot be removed safely because it is within or close to a functional area of the brain (such as areas responsible for movements or speech) or it is in a deep location that is difficult for the surgeons to access.
- On some occasions, laser therapy might be offered as an option following previous surgery if seizures are still not well controlled and the health-care team identifies a single area of seizure origin.
Who does not benefit from laser ablation?
Laser ablation is usually only done in children with a small seizure-generating focus. For larger foci, laser ablation may not be appropriate, and your child’s health-care team might suggest other treatment options. If the focus of the epilepsy is in an area that is easily accessed by surgeons, an open surgery to resect it might be a better alternative option.
What are the benefits of laser ablation?
- It is a minimally invasive technique — it does not involve a craniotomy (opening of the skull) but rather the creation of only one or more small holes on the skull for the insertion of the laser probe.
- Laser ablation is better tolerated than other, more invasive procedures. Children experience less pain and have an early recovery.
- Because it is a minimally invasive technique with real-time monitoring, there is less disruption of healthy brain tissue.
- Serious complications are rare.
- Laser ablation is an effective treatment of foci that cannot be treated with usual surgical techniques, and it results in better seizure control and improved quality of life.
How is laser ablation done?
The procedure is done under general anesthesia. During the first part of the procedure, the surgeon, using a navigation system and a robot, will make one or more small holes in the skull, depending on where the seizure-generating focus is located. Next, your child will be transferred to the MRI for the second part of the procedure, during which the surgeon inserts a laser wire towards the target area through the hole(s) on the skull. The surgical team will carefully monitor the laser as it heats up the target area, which destroys (ablates) the seizure-generating focus using real-time MRI. This helps accurately locate the focus, control the amount of heat delivered and minimize the risk of damage to the surrounding healthy brain.
After the procedure, your child will be woken up and may be moved to the Intensive Care Unit (ICU) briefly for observation. Once your child is stable, they will be moved to the in-patient neurosurgical ward and will also get a short course of steroids to reduce the risk of brain swelling. Children are typically discharged after a few days.
What is the chance of having reduced or no seizures after laser ablation?
The majority of children who undergo laser ablation will either become seizure free or will have a significant reduction in seizure frequency and/or severity. Only a small number of children do not see any improvement at all and may require additional surgery or other treatments if seizures continue. Most children continue taking their anti-seizure medication for at least two years, and the Epilepsy Team will decide if it is appropriate for the medication to be reduced.
Are there any complications associated with laser ablation?
Laser ablation is relatively well tolerated, and complications are rare. Sometimes, the area surrounding the seizure-generating focus may swell, causing headaches, and/or new neurological symptoms such as weakness in the arm or leg, changes in the vision, speech issues, or memory problems depending on the location of the focus. When these symptoms occur, they almost always improve, but on rare occasions, these symptoms are permanent. Your child’s health-care team will give a short course of steroids to minimize that risk. Other rare complications include infection, bleeding, and stroke with permanent neurological deficit and risk to life. The Epilepsy Team will discuss any risks with you prior to surgery.
Care at home
At the time of discharge from the hospital, you will be given detailed instructions about wound care.
It will be normal for your child to feel tired after the procedure. When your child is at home, they should rest for a few days. To manage pain, you can give your child pain medication recommended by the health-care team for a few days following treatment.
Your child should be able to gradually return to normal activities but should avoid any contact sports or activities with risk for head injury. They should be able to return to school when they feel ready, which is typically two to three weeks after treatment.
Follow-up appointments
The first follow-up appointment will be in person with the Neurosurgical Team to assess your child’s recovery after their procedure and their response to the treatment. After that, unless there are any concerns, you will continue to have regular virtual follow ups with both teams (Neurology and Neurosurgery) for ongoing assessment of the treatment response.
Children may have different outcomes depending on the cause and focus of their epilepsy. However, most children who undergo laser therapy for seizures respond well to treatment and can reduce or stop anti-seizure medications. If your child’s epilepsy does not improve with laser therapy or their seizures return, the Epilepsy Team may recommend other treatment options.
When to seek medical attention
Once your child is discharged, there are a few things that you need to look out for.
Contact your child’s surgical team if you notice any of the following:
- Swelling
- Erythema (redness)
- Discharge from the wound
Take your child to the nearest emergency department if your child develops any of the following symptoms:
- Persistent fever
- New worsening headaches
- New neurological symptoms:
- Weakness of the arm or leg
- Trouble speaking or understanding speech
- Vision changes
- Difficulty walking
- New or worsening seizures
- Persistent vomiting or sleepiness
The team at the Emergency Department will complete an initial assessment, and then they should be in touch with your child’s surgical team for advice and further management.
If you think your child has a medical emergency, call 911.
