Evidence on the safety of MRI-guided laser interstitial thermal therapy for drug-resistant epilepsy shows there are serious but well-recognised safety concerns. Evidence on its efficacy is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE guidance page.
Clinicians wishing to do MRI-guided laser interstitial thermal therapy for drug-resistant epilepsy should:
Inform the clinical governance leads in their NHS trusts.
Give patients and their parents or carers clear written information to support shared decision making, including NICE's information for the public.
Ensure that patients and their parents or carers understand the procedure's safety and efficacy, as well as any uncertainties about these.
Audit and review clinical outcomes of all patients having the procedure. NICE has identified relevant audit criteria and developed an audit tool (which is for use at local discretion).
Patient selection should be done by a multidisciplinary team experienced in managing drug-resistant epilepsy. This may include a neurologist, neurosurgeon, neurophysiologist, neuroradiologist and psychiatrist.
The procedure should only be done in specialist centres by clinicians with experience and specific training.
Further research could be in the form of randomised controlled trials, large case series or collaborative registries. It should report details of patient selection, including the size and site of the lesions being created, patient-reported outcomes and long-term follow up, particularly neurodevelopmental outcomes in children.