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. 2024 Jul;65(7):e113-e118.
doi: 10.1111/epi.18005. Epub 2024 May 13.

Disrupting the epileptogenic network with stereoelectroencephalography-guided radiofrequency thermocoagulation

Hellen Kreinter  1 , Poul H Espino  1 , Sonia Mejía  2 , Khalid Alorabi  1 , Greydon Gilmore  1 , Jorge G Burneo  1   3 , David A Steven  1   3 , Keith W MacDougall  1 , Michelle-Lee Jones  1 , Giovanni Pellegrino  1 , David Diosy  1 , Seyed M Mirsattari  1 , Jonathan Lau  1 , Ana Suller Marti  1   4   5
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Disrupting the epileptogenic network with stereoelectroencephalography-guided radiofrequency thermocoagulation

Hellen Kreinter et al. Epilepsia. 2024 Jul.

Abstract

Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) is a treatment option for focal drug-resistant epilepsy. In previous studies, this technique has shown seizure reduction by ≥50% in 50% of patients at 1 year. However, the relationship between the location of the ablation within the epileptogenic network and clinical outcomes remains poorly understood. Seizure outcomes were analyzed for patients who underwent SEEG-guided RF-TC and across subgroups depending on the location of the ablation within the epileptogenic network, defined as SEEG sites involved in seizure generation and spread. Eighteen patients who had SEEG-guided RF-TC were included. SEEG-guided seizure-onset zone ablation (SEEG-guided SOZA) was performed in 12 patients, and SEEG-guided partial seizure-onset zone ablation (SEEG-guided P-SOZA) in 6 patients. The early spread was ablated in three SEEG-guided SOZA patients. Five patients had ablation of a lesion. The seizure freedom rate in the cohort ranged between 22% and 50%, and the responder rate between 67% and 85%. SEEG-guided SOZA demonstrated superior results for both outcomes compared to SEEG-guided P-SOZA at 6 months (seizure freedom p = .294, responder rate p = .014). Adding the early spread ablation to SEEG-guided SOZA did not increase seizure freedom rates but exhibited comparable effectiveness regarding responder rates, indicating a potential network disruption.

Keywords: drug‐resistant epilepsy; radiofrequency thermocoagulation; stereoelectroencephalography.

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References

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