Yan Jingtao, Wang Yuhao, Wang Le, Jin Weipeng, Du Chuan, Li Guangfeng, Cui Deqiu, Yin Shaoya
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China.
Department of Neurosurgery, Jin Cheng People's Hospital, Jincheng City, Shanxi Province, 048026, China.
Acta Epileptol. 2025 Mar 5;7(1):16. doi: 10.1186/s42494-025-00207-5.
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.
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.
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.
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.
立体定向脑电图（SEEG）已成为癫痫手术中广泛应用的诊断方法，具有广泛的临床应用和良好的安全性。SEEG与射频热凝术（RF-TC）联合使用时，有助于识别致痫区，并且作为一种治疗选择，无需全身麻醉，因此不会给患者带来额外费用。本研究旨在调查SEEG引导下的RF-TC是否能提供早期治疗益处。
对2019年4月至2022年12月期间接受RF-TC治疗且有完整随访数据的44例耐药性癫痫患者进行回顾性分析。所有患者在记录到三次或更多次习惯性癫痫发作后进行RF-TC治疗。回顾性评估人口统计学特征，并使用恩格尔分类系统评估治疗结果。
所有患者均成功进行了SEEG引导下的RF-TC治疗，无明显神经并发症。每位患者平均植入7.7±0.4根电极，SEEG监测持续时间为7.5天（范围：6.8 - 11天）。热凝术后随访时间为9至63个月。在三个月的随访中，56.8%的患者达到恩格尔I级（11例）和II级（14例）。在六个月的随访中，40.9%的患者达到恩格尔I级（9例）和II级（9例），有5名患者进行了手术治疗。到12个月的随访时，40.9%的患者达到恩格尔I级（5例）和II级（13例），累计共有12名患者接受了手术干预。在24个月的随访中，20.5%的患者达到恩格尔I级（3例）和II级（6例），累计共有16名患者接受了手术治疗。在所有44例患者中，热凝术前和术后观察到癫痫发作频率有统计学意义的降低（P = 0.007），尽管热凝术的治疗效果随时间下降。
SEEG引导下的RF-TC是治疗耐药性癫痫的一种安全有效的治疗方式。然而，随着随访时间的延长，RF-TC后的无癫痫发作率和有效率逐渐下降。
