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- Title
Stereo electroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in drug-resistant focal epilepsy: Results from a 10-year experience.
- Authors
Bourdillon, Pierre; Isnard, Jean; Catenoix, Hélène; Montavont, Alexandra; Rheims, Sylvain; Ryvlin, Philippe; Ostrowsky ‐ Coste, Karine; Mauguiere, François; Guénot, Marc
- Abstract
Objective Stereo electroencephalography ( SEEG)-guided radiofrequency thermocoagulation ( SEEG-guided RF- TC) has been proposed since 2004 as a possible treatment of some focal drug-resistant epilepsy. The aim of this study is to provide extensive data about efficacy and safety of SEEG-guided RF- TC. Methods Over a 10-year period, 162 patients with drug-resistant focal epilepsy were eligible for SEEG-guided RF- TG during phase II invasive investigation by SEEG. All follow-up and safety data were collected prospectively. The primary outcome was seizure freedom at 2 months and at 1 year after SEEG-guided RF- TC. Secondary outcomes were the responders' rate (patient with at least 50% decrease in seizure frequency) and their long-term follow-up. Results Twenty-five percent of patients were seizure-free at 2 months and 7% at 1 year. We reported 67% of responders at 2 months and 48% at 1 year; 58% of responders maintained their status during the long-term follow-up. The seizure outcome was significantly better when the SEEG-guided RF- TC involved the occipital region (p = 0.007). When surgery followed an SEEG-guided RF- TC, the positive predictive value of being a responder 2 months after an SEEG-guided RF- TC and to be Engel's class I or II after surgery was 93%. We reported 1.1% of permanent deficit and 2.4% of transient side effects. Significance Our results, gathered in a large population over a 10-year period, confirm that SEEG-guided RF- TC is a safe technique, being efficient in many cases. More than two thirds of patients showed a short-term improvement, and almost half of them were responders at 1-year follow-up. The technique appears to be especially interesting for limited epileptic zone inaccessible to surgery and when epilepsy is related to a large unilateral network (network disruption by multiple RF- TC). Furthermore, SEEG-guided RF- TC effect is a predictor of outcome after conventional cortectomy in patients eligible for surgery.
- Subjects
PARTIAL epilepsy; DRUG resistance; ELECTROENCEPHALOGRAPHY; ELECTROCOAGULATION (Medicine); STEREOTACTIC radiosurgery; MAGNETOENCEPHALOGRAPHY
- Publication
Epilepsia (Series 4), 2017, Vol 58, Issue 1, p85
- ISSN
0013-9580
- Publication type
Article
- DOI
10.1111/epi.13616