Laser interstitial thermal therapy for refractory epilepsy in children under 2 years: A single-center case series and review of the literature.

OBJECTIVE

To evaluate the safety, feasibility, and clinical outcomes of magnetic resonance-guided laser interstitial thermal therapy (LITT) in children under 2 years of age with medically refractory epilepsy.

METHODS

We conducted a retrospective case series of five infants who underwent LITT at a tertiary pediatric epilepsy center. Inclusion criteria were age ≤ 24 months, failure of at least two antiseizure medications, and presence of a focal structural lesion on imaging. Clinical data, seizure outcomes (Engel classification), and developmental trajectories were analyzed.

RESULTS

Five patients (mean age at LITT: 9 months) underwent laser ablation for focal cortical dysplasia (FCD; n = 3) or tuberous sclerosis complex (TSC; n = 2). All patients tolerated the procedure without complications. At 12 months post-LITT, 3/5 patients (60%) achieved Engel Class I outcomes, all of whom had FCD. Both patients with TSC had ongoing seizures, although one showed improvement after subsequent SEEG-guided open resection. Patients with FCD demonstrated robust developmental progress, whereas those with TSC exhibited only modest gains in attention, engagement, and fine motor skills.

CONCLUSION

LITT is a safe and feasible option for selected infants with drug-resistant epilepsy and structural lesions. Favorable seizure and developmental outcomes were more commonly observed in patients with FCD than TSC. These findings support further study of LITT in this age group, with particular attention to early intervention and accurate localization in complex cases.