New insights from MRI-guided laser interstitial thermal therapy for refractory epilepsy: a state-of-the-art overview.

INTRODUCTION

Recently, MRI-guided laser interstitial thermal therapy (MRgLITT) has emerged as a therapeutic option for drug-resistant epilepsy (DRE). However, the absence of standardized clinical guidelines remains a significant issue.

OBJECTIVE

To conduct a systematic review of systematic reviews to provide a descriptive assessment of the quality of evidence regarding the application of MRgLITT for DRE.

METHODS

We conducted a comprehensive search in PubMed, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar up to May 30th, 2024. We evaluated the risk of bias in each study using the AMSTAR-2 tool. The primary outcomes assessed were seizure freedom and perioperative or postoperative complications rate, while the secondary outcome was reoperation rate. The certainty of the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Finally, pertinent findings were illustrated in a bubble plot.

RESULTS

A total of 16 systematic reviews met eligibility criteria, just including observational studies (cohorts and case series). Fourteen SRs scored "Critically low" with a median 8 [IQR: 5.25-8.25]. Seizure freedom rate ranged from 18.87% to 75.86%, and the most frequent cause of DRE was mesial temporal lobe epilepsy. The most common complications were visual field deficit (2.17%-7.5%) and intracranial hemorrhage (0.96%-8.6%). All the outcomes reported a "very low" certainty of evidence, as randomized studies were absent in the reviews.

CONCLUSION

This overview provides comprehensive evidence on the application of MRgLITT for DRE). The evidence indicates a seizure freedom rate ranging from 18.87% to 75.86% with certainty levels raning from critically low to low. While these findings are promising, further primary and secondary studies are essential to establish definitive conclusions and assess the potential for future clinical applications or recommendations.

PROTOCOL REGISTRATION NUMBER: CRD42022339024.