Lesion focused stereotactic thermo-coagulation of focal cortical dysplasia IIB: A new approach to epilepsy surgery?

Wellmer, Jörg; Kopitzki, Klaus; Voges, Jürgen

doi:10.1016/j.seizure.2014.01.024

Cited by 35 publications

(29 citation statements)

References 11 publications

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“…23 In our experience, none of the 11 patients with an FCD (2 Type I and 9 Type II) achieved seizure freedom. A possible explanation is that we usually proceed to surgical resection with no invasive recording in patients with an FCD similar to the FCDs reported by Wellmer et al, 23 whereas SEEG is reserved for patients with more extended cortical malformations, which are addressed less easily by focused RF-TC. Seizure outcomes were more favorable in lesional than in nonlesional cases (25.6% and 10.9% of patients seizure free, respectively).…”

Section: Seizure Outcome After Rf-tcmentioning

confidence: 63%

“…Indeed, apart from the pioneering reports on SEEGguided RF-TC by a group of authors in Lyon, France, 4,12,13 recent studies on stereotactic TC have included patients with only noninvasive evaluation, 7 a few patients who underwent invasive EEG, 11,16,24 and individual patients who underwent local recording of electroencephalographic activity in the lesion targeted for coagulation. 21,23 Therefore, because the seizure outcome of patients who require invasive EEG is generally less favorable, the contribution of RF-TC in controlling or improving seizures in our patients should be evaluated.…”

Section: Pretreatment Evaluationmentioning

confidence: 99%

“…With the advent of modern imaging techniques and the increasing accuracy of stereotactic targeting, interest in stereotactic ablative procedures, specifically radiofrequency thermocoagulation (RF-TC), has recently gained new popularity. Promising results in temporal lobe epilepsy 14,16,17 and in epilepsies symptomatic of certain malformative lesions 15,21,23 have been reported. Nevertheless, the role of this minimally invasive procedure in patients with more complex drug-resistant focal epilepsy, which may require invasive electroencephalography (EEG) evaluation, and in those who are not optimal candidates for resective surgery is still unclear.…”

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confidence: 99%

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Stereoelectroencephalography-guided radiofrequency thermocoagulation in the epileptogenic zone: a retrospective study on 89 cases

Cossu

Fuschillo

Casaceli

et al. 2015

JNS

119

137

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aBBreViatiONS EEG = electroencephalography; EZ = epileptogenic zone; FCD = focal cortical dysplasia; MTLE = mesial temporal lobe epilepsy; RF-TC = radiofrequency thermocoagulation; SEEG = stereoelectroencephalography. SuBmitted August 28, 2014. accepted December 8, 2014. iNclude wheN citiNg Published online June 19, 2015; DOI: 10.3171/2014.12.JNS141968. diSclOSure Dr. Cardinale is a consultant for Renishaw Mayfield SA, the manufacturer of Neuromate, and a former consultant for Medtronic, the manufacturer of the O-arm device. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. OBJect Radiofrequency thermocoagulation (RF-TC) of presumed epileptogenic lesions and/or structures has gained new popularity as a treatment option for drug-resistant focal epilepsy, mainly in patients with mesial temporal lobe epilepsy. The role of this minimally invasive procedure in more complex cases of drug-resistant epilepsy, which may require intracranial electroencephalographic evaluation, has not been fully assessed. This retrospective study reports on a case series of patients with particularly complex focal epilepsy who underwent stereoelectroencephalography (SEEG) evaluation with stereotactically implanted multicontact intracerebral electrodes for the detailed identification of the epileptogenic zone (EZ) and who received RF-TC in their supposed EZ (according to SEEG findings). methOdS Eighty-nine patients (49 male and 40 female; age range 2-49 years) who underwent SEEG evaluation and subsequent RF-TC of the presumed EZ at the authors' institution between January 2008 and December 2013 were selected. Brain MRI revealed structural abnormalities in 43 cases and no lesions in 46 cases. After SEEG, 67 patients were judged suitable for resective surgery (Group 1), whereas surgery was excluded for 22 patients (Group 2). Thermocoagulation was performed in each of these patients by using the previously implanted multicontact recording electrodes and delivering RF-generated currents to adjacent electrode contacts. reSultS The mean number of TC sites per patient was 10.6 ± 7.2 (range 1-33). Sustained seizure freedom occurred after TC in 16 patients (18.0%) (13 in Group 1 and 3 in Group 2). A sustained worthwhile improvement was reported by 9 additional patients (10.1%) (3 in Group 1 and 6 in Group 2). As a whole, 25 patients (28.1%) exhibited a persistent significant improvement in their seizures. More favorable results were observed in patients with nodular heterotopy (p = 0.0001389), those with a lesion found on MRI (not significant), and those with hippocampal sclerosis (not significant). Other variables significantly correlated to seizure freedom were the patient's age (p = 0.02885) and number of intralesional TC sites (p = 0.0271). The patients in Group 1 who did not benefit at all (21 patients) or who experienced only a transient benefit (30 patients) from TC underwent microsurgical resection of their EZ. Thermocoagulation was followed by se...

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Section: Seizure Outcome After Rf-tcmentioning

confidence: 63%

Section: Pretreatment Evaluationmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Stereoelectroencephalography-guided radiofrequency thermocoagulation in the epileptogenic zone: a retrospective study on 89 cases

Cossu

Fuschillo

Casaceli

et al. 2015

JNS

119

137

View full text Add to dashboard Cite

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“…Such localized, single-stage approaches to these small dysplastic lesions are sparsely reported. 31,32,39 Single-stage resections in eloquent cortical regions, without prior cortical stimulation or awake functional monitoring, need to be undertaken with preservation of the cortex and vascular supply to the adjacent gyral crowns, avoidance of injury to the subcortical white matter tracts, and knowledge that FCD type 2A lesions (usually without a transmantle sign on MRI) may contain cortical function.…”

Section: Methods Patient Ascertainmentmentioning

confidence: 99%

The surgically remediable syndrome of epilepsy associated with bottom-of-sulcus dysplasia

et al. 2015

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Objective: To determine clinical and EEG features that might help identify patients with epilepsy harboring small, intrinsically epileptogenic, surgically treatable, bottom-of-sulcus dysplasias (BOSDs).Methods: Retrospective review of clinical records, EEG, MRI, and histopathology in 32 patients with drug-resistant epilepsy and MRI-positive (72% 3.0 tesla), pathologically proven (type 2B cortical dysplasia) BOSDs operated at our centers during 2005-2013. Results: Localization of BOSDs was frontal in 19, insula in 5, parietal in 5, and temporal in 3, on the convexity or interhemispheric surfaces. BOSDs were missed on initial MRI at our centers in 22% of patients. Patients presented with focal seizures during infancy in 9, preschool years in 15, and school years in 8 (median age 5 years). Seizures were stereotyped, predominantly nocturnal, and typically nonconvulsive, with semiology referable to the fronto-central or perisylvian regions. Seizures occurred at high frequency during active periods, but often went into prolonged remission with carbamazepine or phenytoin. Intellect was normal or borderline, except in patients with seizure onset during infancy. Scalp EEG frequently revealed localized interictal epileptiform discharges and ictal rhythms. Patients underwent lesionectomy (median age 14 years) guided by electrocorticography and MRI, with prior intracranial EEG monitoring in only one patient. Twentyeight patients (88%) became seizure-free, and 20 discontinued antiepileptic medication (median follow-up 4.1 years). Conclusions:In patients with cryptogenic focal epilepsy, this clinical presentation and course should prompt review of or repeat MRI, looking for a BOSD in the frontal, parietal, or insula cortex. If a BOSD is identified, the patient might be considered for single-stage lesionectomy. Bottom-of-sulcus dysplasia (BOSD)1 is a localized variety of type 2 focal cortical dysplasia (FCD) in which the dysplastic features are maximal at the sulcal depth, tapering to a relatively normal gyral crown.2,3 Pathologically, BOSDs are characterized by neuronal dyslamination and dysmorphology, with or without balloon cells, at the bottom of the sulcus, with hypomyelination in the underlying white matter. 2,4,5 The characteristic MRI features of BOSD are cortical thickening, gray-white junction blurring, and subcortical T2 hyperintensity, often tapering to the ventricle as a "transmantle sign." [6][7][8][9] Straightening and elongation of the dysplastic sulcus, and depression or unusual sulcation of the overlying cerebral surface, may also be appreciated. 8,10,11 BOSDs are typically found in the frontal and parietal lobes.

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“…The first paper on stereotactic lesion on epilepsy was published in 1965 [17] . Since then, stereotactic lesion as a surgical treatment for focal epilepsy gained widespread use [18] , mainly as an alternative to conventional surgery in patients with mesial temporal lobe epilepsy (MTLE) [19][20][21] , especially with hippocampal sclerosis [22][23][24] and malformation of cortical development (MCD) [25][26][27] . The mesial temporal lobe structures (amygdala and hippocampus) have been targeted; however, due to the poor results in MTLE compared to conventional open surgery, the technique was almost entirely abandoned [21] .…”

Section: Introductionmentioning

confidence: 99%

Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in patients with drug-resistant focal epilepsy

2017

Transl. Neurosci. Clin.

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For some patients with drug-resistant focal epilepsy, we usually select conventional surgical resection, which has brought better outcomes. However, others are not eligible for a conventional open surgical resection of the epileptogenic zone because of the proximity of a functional area or the implication of a larger epileptogenic network. Initially, stereoelectroencephalography (SEEG) exploration was a method of electroencephalography recording that was used in the presurgical evaluation of epileptic patients with complex epilepsy. Later, intracerebral electrodes used for SEEG were applied to produce radio frequency thermocoagulation (RF-TC) in epileptic patients. SEEG-guided RF-TC has produced some promising results, especially in the last dacade. Now, it has become popular as a palliative treatment to reduce seizure frequency in patients with drug-resistant focal epilepsy. This article presents a review of SEEG-guided RF-TC.Citation Xu CW, Zhou WJ. Stereoelectroencephalography guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in drug-resistant focal epilepsy. Transl. Neurosci. Clin. 2017, 3(1): 40-47.

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Lesion focused stereotactic thermo-coagulation of focal cortical dysplasia IIB: A new approach to epilepsy surgery?

Cited by 35 publications

References 11 publications

Stereoelectroencephalography-guided radiofrequency thermocoagulation in the epileptogenic zone: a retrospective study on 89 cases

Stereoelectroencephalography-guided radiofrequency thermocoagulation in the epileptogenic zone: a retrospective study on 89 cases

The surgically remediable syndrome of epilepsy associated with bottom-of-sulcus dysplasia

Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in patients with drug-resistant focal epilepsy

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