Wang Le, Jin Weipeng, Zhang Yan, Wang Shimin, Li Qingyun, Qin Jie, Li Zhitao, Cheng Yifeng, Feng Keke, Yin Shaoya
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.
Department of Functional Neurosurgery, Huanhu Hospital, Tianjin, China.
Ann Transl Med. 2022 Feb;10(4):192. doi: 10.21037/atm-21-6851.
Stereoelectroencephalography (SEEG) has become a common diagnostic method in epilepsy surgery and is found to be safe for a wide range of clinical applications. SEEG combined with radiofrequency thermocoagulation (RF-TC) not only reveals the seizure onset zone by hypothesis, but also acts as a treatment option without any additional cost to institutions and patients. Thus, we analyzed the treatment of the SEEG-guided RF-TC.
This retrospective study analyzed seventeen epileptic patients treated with RF-TC between April 2019 and December 2020. All patients underwent a single round of SEEG-guided RF-TC treatment after more than three habitual seizures were recorded. The demographic characteristics of the patients were retrospectively reviewed. Outcomes were assessed using the Engel classification system.
All patients underwent SEEG-guided RF-TC without catastrophic functional damage. Follow-up data of all patients were complete. The number of contacts per patients where RF-TC was applied ranged from 9 to 43 (mean: 17.7±10.2). After RF-TC, the types of anti-epileptic drugs used reduced from 2.4±0.7 to 1.6±0.7. With RF-TC alone, four (23.5%) patients achieved Engel Ia, two (11.8%) patients achieved Engel Ib, one patient underwent resection without seizure at the 5-month follow-up, five patients had a relapse after 3-10 months of seizure freedom, and five patients had recurrence after 1 month. After RF-TC, six patients underwent secondary interventions followed by resection. Overall, 12 patients achieved Engel Ia or Ib, three patients achieved Engel IIa or IIb, and two patients achieved Engel IIIa. There were no Engel IV cases.
SEEG-guided RF-TC performed in our institution was found to be a safe ablation procedure for the treatment of drug-resistant focal epilepsy. All patients experienced a reduction in the frequency of seizures after receiving RF-TC. RF-TC can be used as a palliative treatment option for patients with epilepsy who refuse surgery or cannot undergo resection surgery. Recurrence of focal epilepsy after RF-TC can be treated with resection surgery to achieve the seizure-free status.
立体定向脑电图（SEEG）已成为癫痫手术中一种常见的诊断方法，并且被发现在广泛的临床应用中是安全的。SEEG联合射频热凝术（RF-TC）不仅通过假设揭示癫痫发作起始区，而且作为一种治疗选择，对机构和患者而言无需任何额外费用。因此，我们分析了SEEG引导下的RF-TC治疗。
这项回顾性研究分析了2019年4月至2020年12月期间接受RF-TC治疗的17例癫痫患者。所有患者在记录到超过三次习惯性发作后均接受了一轮SEEG引导下的RF-TC治疗。回顾性分析了患者的人口统计学特征。使用恩格尔分类系统评估结果。
所有患者均接受了SEEG引导下的RF-TC治疗，未出现灾难性功能损害。所有患者的随访数据完整。应用RF-TC的每位患者的电极触点数量为9至43个（平均：17.7±10.2）。RF-TC后，使用的抗癫痫药物类型从2.4±0.7种减少至1.6±0.7种。仅通过RF-TC，4例（23.5%）患者达到恩格尔Ia级，2例（11.8%）患者达到恩格尔Ib级，1例患者在5个月随访时无癫痫发作且接受了切除手术，5例患者在无癫痫发作3至10个月后复发，5例患者在1个月后复发。RF-TC后，6例患者接受了二次干预并随后进行了切除手术。总体而言，12例患者达到恩格尔Ia级或Ib级，3例患者达到恩格尔IIa级或IIb级，2例患者达到恩格尔IIIa级。无恩格尔IV级病例。
在我们机构进行的SEEG引导下的RF-TC被发现是一种治疗耐药性局灶性癫痫的安全消融手术。所有患者在接受RF-TC后癫痫发作频率均有所降低。RF-TC可作为拒绝手术或无法接受切除手术的癫痫患者的姑息治疗选择。RF-TC后局灶性癫痫复发可通过切除手术治疗以实现无癫痫发作状态。
