Stereoelectroencephalography-guided three-dimensional radiofrequency thermocoagulation for the treatment of drug-resistant epilepsy

Abstract

Objective To investigate the safety and efficacy of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) with three-dimensional lesioning in the treatment of drug-resistant epilepsy. Methods Forty-eight patients with drug-resistant epilepsy who underwent SEEG-guided RF-TC with three-dimensional ablation at Neurosurgery Department of Xuanwu Hospital Capital Medical University from July 2015 to December 2017 were retrospectively enrolled into this study. There were 22 cases of mesial temporal lobe epilepsy (MTLE), 9 cases of hypothalamic hamartoma, 5 cases of frontal lobe epilepsy, 4 cases of insular lobe epilepsy, 1 case of periventricular nodular heterotopia, 1 case of tuberous sclerosis and 6 cases of multi-focal epilepsy. The clinical efficacy was evaluated based on the Engel grading system and the relevant complications were documented. Results The follow-up duration was 5-35 months, with an average of 16.3±7.3 months. The overall outcome was Engel Ⅰ in 23 (47.9%) cases, Engel Ⅱ in 12 (25.0%), Engel Ⅲ in 11 (22.9%) and Engel Ⅳ in 2 (4.2%). There were 71.9% (23/32) of patients who were seizure free at 1 year follow-up. The outcome was better in MTLE and hypothalamic hamartoma epilepsies, with Engel grade Ⅰ ratio of 59.1% (13/22) and 5/9 respectively. Multi-focal epilepsies (Engel grade Ⅲ: 4 out of 6 cases), frontal lobe epilepsies (Engel grade Ⅲ: 1 out of 5), Engel grade Ⅳ: 2 out of 5) had relatively poor curative effect. Transient complications following thermocoagulation occurred in 7 (14.6%) cases and permanent complications in 1 (2.1%). Conclusions SEEG-guided RF-TC with three-dimensional lesioning is minimally invasive, safe and effective in the treatment of drug-refractory epilepsy. Compared with other types of epilepsies, MTLE and hypothalamic hamartoma epilepsies have relatively better efficacy and RF-TC can be a complementary treatment for resective surgery. Key words: Epilepsy; Stereoelectroencephalography; Radiofrequency thermocoagulation; Three-dimensional