Whether radiofrequency thermocoagulation guided by stereotactic electroencephalography can benefit drug-resistant epilepsy in the early follow-up stage.

Abstract

Background: Stereotactic electroencephalography (SEEG) has emerged as a widely utilized diagnostic approach in epilepsy surgery, demonstrating broad clinical applications and a favorable safety profile. SEEG, when combined with radiofrequency thermocoagulation (RF-TC), facilitates the identification of epileptogenic zones and serves as a therapeutic option that eliminates the need for general anesthesia, thus incuring no additional costs for patients. This study aimed to investigate whether SEEG-guided RF-TC provides early therapeutic benefits.

Methods: A retrospective analysis was performed on 44 patients with drug-resistant epilepsy who underwent RF-TC treatment between April 2019 and December 2022, with complete follow-up data available. RF-TC was administered after the recording three or more habitual epileptic seizures in all patients. Demographic characteristics were retrospectively assessed, and treatment outcomes were evaluated using the Engel classification system.

Results: SEEG-guided RF-TC treatment was successfully performed in all patients without significant neurological complications. An average of 7.7 ± 0.4 electrodes were implanted per patient, with a SEEG monitoring duration of 7.5 days (range: 6.8-11). Follow-up after thermocoagulation ranged from 9 to 63 months. At the three-month follow-up, 56.8% of patients achieved Engel I (11 cases) and II (14 cases) were included. At the six-month follow-up, 40.9% of patients achieved Engel grades I (9 cases) and II (9 cases), with five patients proceeding to surgical treatment. By the 12-month follow-up, 40.9% of patients reached Engel grades I (5 cases) and II (13 cases), with a cumulative total of 12 patients undergoing surgical intervention. At the 24-month follow-up, 20.5% of patients achieved Engel grades I (3 cases) and II (6 cases), resulting in a cumulative total of 16 patients undergoing surgical treatment. A statistically significant reduction in seizure frequency was observed before and after thermocoagulation in all 44 patients (P = 0.007), although the therapeutic effect of thermocoagulation decreased over time.

Conclusions: SEEG-guided RF-TC is a safe and effective treatment modality for drug-resistant epilepsy. However, as follow-up duration increases, both seizure-free rates and response rates following RF-TC progressively decline.