Late Results of Stereotactic Radiofrequency Lesions in Epilepsy

Marossero, F; Ravagnati, L.; Sironi, V. A.; Miserocchi, Giuseppe; Franzini, Andrea; Ettorre, G; Cabrini, G

doi:10.1007/978-3-7091-8592-6_18

Cited by 24 publications

(10 citation statements)

References 1 publication

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“…Stereotactic ablative procedures of amygdala, hippocampus, or other limbic structures in patients with epilepsy were reported in several studies, with conflicting results on seizures. Some studies included patients with a diagnosis of temporal lobe epilepsy (TLE) or “psychomotor seizures,” whereas others reported on patients with unspecified epileptic disorders . The efficacy of the procedure on seizures was controversial, with the seizure outcome being difficult to interpret owing to differences in outcome assessment and in the length of postoperative follow‐up, and with a high variability in the rate of seizure‐free or markedly improved patients (from 6 to 63%).…”

Section: Historical Backgroundmentioning

confidence: 99%

Stereo‐EEG–guided radiofrequency thermocoagulations

Cossu¹,

Cardinale²,

Casaceli³

et al. 2017

Epilepsia

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SUMMARYThe rationale and the surgical technique of stereo-electroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) in the epileptogenic zone (EZ) of patients with difficult-to-treat focal epilepsy are described in this article. The application of the technique in pediatric patients is also detailed. Stereotactic ablative procedures by RF-TC have been employed in the treatment of epilepsy since the middle of the last century. This treatment option has gained new popularity in recent decades, mainly because of the availability of modern imaging techniques, which allow accurate targeting of intracerebral epileptogenic structures. SEEG is a powerful tool for identifying the EZ in the most challenging cases of focal epilepsy by recording electrical activity with tailored stereotactic implantation of multilead intracerebral electrodes. The same recording electrodes may be used to place thermocoagulative lesions in the EZ, following the indications provided by intracerebral monitoring. The technical details of SEEG implantation and of SEEG-guided RF-TC are described herein, with special attention to the employment of the procedure in pediatric cases. SEEG-guided RF-TC offers a potential therapeutic option based on robust electroclinical evidence with acceptable risks and costs. The procedure may be performed in patients who, according to SEEG recording, are not eligible for resective surgery, and it may be an alternative to resective surgery in a small subset of operable patients.

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Section: Historical Backgroundmentioning

confidence: 99%

Stereo‐EEG–guided radiofrequency thermocoagulations

Cossu¹,

Cardinale²,

Casaceli³

et al. 2017

Epilepsia

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“…Several lesioning techniques have been proposed, but the use of RF heating remains the most popular due to its intrinsic advantages . From the 1970s to the 1990s, stereotactic lesioning as a surgical treatment of focal epilepsy was largely developed, mainly as an alternative to conventional surgery in mesial temporal lobe epilepsy (MTLE) . However, due to the rather disappointing results of this technique in MTLE compared to those of conventional surgery, the technique has been almost totally abandoned.…”

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confidence: 99%

“…5 From the 1970s to the 1990s, stereotactic lesioning as a surgical treatment of focal epilepsy was largely developed, 6 mainly as an alternative to conventional surgery in mesial temporal lobe epilepsy (MTLE). [7][8][9] However, due to the rather disappointing results of this technique in MTLE compared to those of conventional surgery, the technique has been almost totally abandoned. These early results have been obtained from single lesion procedures guided by noninvasive investigations we started in 2004 10 to reinvestigate the outcome of stereotactic surgery in the treatment of focal epilepsies by using stereo electroencephalography (SEEG) recordings of ictal activity to guide RF thermocoagulation (RF-TC).…”

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Stereo electroencephalography–guided radiofrequency thermocoagulation (SEEG‐guided RF‐TC) in drug‐resistant focal epilepsy: Results from a 10‐year experience

et al. 2016

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SUMMARYObjective: 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.

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“…In case of adjacent eloquent cortex, this approach must be abandoned or is further complicated by the need for invasive electroencephalography (EEG) monitoring, such as implementation of grid electrodes. As far back as 60 years ago, stereotactically guided radiofrequency lesioning (RFL) using depth electrode recordings in the rhinencephalon was thought to circumvent this problem (Marossero et al., 1980). Generally accepted indications and target zones for this procedure, however, have been missing since (Ojemann & Ward, 1975).…”

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Radiofrequency lesioning for epileptogenic periventricular nodular heterotopia: A rational approach

Schmitt¹,

Voges

Buentjen

et al. 2011

Epilepsia

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SUMMARYPeriventricular nodular heterotopias (PNHs) are frequently associated with pharmacoresistant epilepsy. They are considered part of a dysfunctional network, connected to the overlying cortex. Therefore, removal of the PNHs and additional cortectomy or lobectomy seem to be essential for significant and long-lasting seizure reduction. These procedures, however, can have considerable limitations, especially in patients with functional eloquent cortex adjacent to the PNH. Alternatively, stereotactic neurosurgery can reduce the surgical trauma. Presented is a 56-year-old man who became seizure-free after stereotactically guided radiofrequency lesioning of a solitary PNH. KEY WORDS: Epileptogenity, Epilepsy surgery, Network, Stereotaxy, Thermoablation, Thermocoagulation.Pharmacologic treatment of patients with periventricular nodular heterotopias (PNHs) is oftentimes unsatisfactory (Raymond et al., 1994), even if the extent of PNH is limited to one brain region and neurologic examination is normal (D'orsi et al., 2004). Standard resective neurosurgery also does not necessarily result in cessation of seizures (Li et al., 1997). In case of adjacent eloquent cortex, this approach must be abandoned or is further complicated by the need for invasive electroencephalography (EEG) monitoring, such as implementation of grid electrodes. As far back as 60 years ago, stereotactically guided radiofrequency lesioning (RFL) using depth electrode recordings in the rhinencephalon was thought to circumvent this problem (Marossero et al., 1980). Generally accepted indications and target zones for this procedure, however, have been missing since (Ojemann & Ward, 1975).The presented case illustrates that RFL can be used to deactivate effectively an epileptogenic zone associated with PNH if it is performed in combination with high-resolution magnetic resonance imaging (MRI) and electrophysiologic selected target detection. Patient and MethodOn admission, this 56-year-old, right-handed male patient presented with poorly controlled epilepsy manifested as frequent unspecific auras, daily clonic, aphasic seizures and one bilateral tonic-clonic seizure per week. In addition, he complained about memory and concentration difficulties. Current treatment was lamotrigine 850 mg/day and carbamazepine 800 mg/day.Since onset of epilepsy at the age of 3, several antiepileptic drugs have been used. From childhood to adolescence, the patient took phenobarbital, phenytoin, and valproic acid. Later oxcarbazepine and topiramate treatment was discontinued because of poor seizure control and intolerable sideeffects. Birth and child development was unremarkable other than for measles encephalitis in early childhood. A third-degree relative of the patient allegedly had epilepsy. He had no other affliction apart from medically controlled hyperlipidemia.The main findings on cranial MRI (Fig. 1A) were a solitary PNH dorsal to the left caput caudatum at the level of the ventricular wall and atrophy of the left-sided superior insular cortex and the cerebellum. ...

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Late Results of Stereotactic Radiofrequency Lesions in Epilepsy

Cited by 24 publications

References 1 publication

Stereo‐EEG–guided radiofrequency thermocoagulations

Stereo‐EEG–guided radiofrequency thermocoagulations

Stereo electroencephalography–guided radiofrequency thermocoagulation (SEEG‐guided RF‐TC) in drug‐resistant focal epilepsy: Results from a 10‐year experience

Radiofrequency lesioning for epileptogenic periventricular nodular heterotopia: A rational approach

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