SEEG‐guided RF Thermocoagulation of Epileptic Foci: Feasibility, Safety, and Preliminary Results

Guénot, Marc; Isnard, Jean; Ryvlin, Philippe; Fischer, Catherine; Mauguı̀ere, François; Sindou, Marc

doi:10.1111/j.0013-9580.2004.17704.x

Cited by 142 publications

(127 citation statements)

References 38 publications

(41 reference statements)

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“…Unlike stereotaxic electroencephalography-guided radiofrequency thermocoagulation [2], our procedures do not intentionally damage targeted cortical sites, although small brain lesions are likely. In our first case, intracerebral electrode trajectories frequently crossed white matter potentially disturbing seizure propagation pathways.…”

Section: Discussionmentioning

confidence: 99%

Seizure freedom after intracranial electrode implantation in pharmacoresistant epilepsy

Nguyen‐Michel

Dupont

Thivard

et al. 2017

Euro J of Neurology

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A 33-year-old man had experienced several seizures per month (partial or generalized) since childhood despite multiple antiepileptic drug (AED) polytherapies. Video-electroencephalography, fluorodeoxyglucose-positron emission tomography and subtraction ictal-interictal single photon emission computed tomography coregistered with magnetic resonance imaging led to the diagnosis of magnetic resonance imaging-negative left temporal lobe (TL) epilepsy. He underwent videointracranial electroencephalography with nine electrodes implanted in the left TL ( Fig. 1a and c; Data S1). Three seizures were recorded, characterized by fear and gestural/oral automatisms, and sometimes right-sided clonic jerks and generalization. Ictal discharges originated in the left temporal pole, spread to the hippocampus and then other brain regions (Fig. S1). A left temporal polar resection was contemplated but not performed, as seizures did not recur after electrode removal and at follow-up of 4 years, despite AED reduction. Case 2A 37-year-old man had developed daily focal seizures refractory to AED polytherapies since the age of 8 years. Video-electroencephalography, magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography indicated non-lesional bilateral TL epilepsy. He underwent video-intracranial electroencephalography with Spencer electrodes and subdural strips to explore both TLs (Fig. 1b). Six seizures were recorded, one asymptomatic and the others with gestural/oral automatisms and moaning. Fast ictal discharges emerged from the left amygdalar-hippocampal-entorhinal cortex, sometimes accompanied by slow rhythmic spikes and waves in the right hippocampus, and bilateral fast development (Fig. S2). Interictal spikes were abundant in the right hippocampus. Surgery was postponed because of uncertain outcome. Unexpectedly, seizures did not recur over a period of 14 years after electrode removal, despite AED reduction.The patients gave informed consent for participation. No ethics board approval was needed because it was a retrospective case report based on medical records. DiscussionOur cases were drawn from a series of 163 implanted patients [1]. Remarkably, implantation was followed by a prolonged, complete remission of epileptic seizures that could not be traced to surgical complications or changes in AED.The minimal perturbation due to intracranial electrodes evidently sometimes has strong effects on human epileptic networks.Unlike stereotaxic electroencephalography-guided radiofrequency thermocoagulation [2], our procedures do not intentionally damage targeted cortical sites, although small brain lesions are likely. In our first case, intracerebral electrode trajectories frequently crossed white matter potentially disturbing seizure propagation pathways. In the second case, only Spencer electrodes were intracerebral and their trajectory was mostly intrahippocampal through the long axis of the hippocampi. These electrodes are relatively small (1 mm). Presumably they cause little disruption of lamellar or non-lam...

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Section: Discussionmentioning

confidence: 99%

Seizure freedom after intracranial electrode implantation in pharmacoresistant epilepsy

Nguyen‐Michel

Dupont

Thivard

et al. 2017

Euro J of Neurology

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“…All noninvasive presurgical investigations are not sufficiently congruent for localizing the epileptogenic zone; hence, SEEG is performed before surgery [31] .…”

Section: Indicationsmentioning

confidence: 99%

“…Furthermore, habitual seizures during RF-TC are not a major concern [28] . Heat sensation can be due to the proximity of the lesion site to the pericerebral cistern and can be a warning sign against unintentional injury to the optic tract or brainstem [31] .…”

Section: Safetymentioning

confidence: 99%

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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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“…43 Mais recentemente, alguns casos na literatura foram descritos do uso do EP para fins terapêuticos, causando lesões por termo coagulação em pacientes com uma ZE limitada e bem confinada a região de um contado do eletrodo ou quando a cirurgia ressectiva é contraindicada. 49 EP têm sido também utilizados para indicações menos convencionais, como na estimulação cerebral profunda, como por exemplo, dos núcleos subtalâmicos, encontrando um novo cenário de atuação. 50 Atualmente, para fins de pesquisa, os EP podem ter acoplado a si, sondas para micro diálise, podendo assim examinar a concentração de substâncias no líquor ou no tecido cerebral de interesse.…”

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Estereoeletroencefalografia na era da cirurgia guiada por imagem

Centeno

Yacubian

Caboclo

et al. 2009

J. epilepsy clin. neurophysiol.

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RESUMOIntrodução: A estereoeletroencefalografia (E-EEG), conforme introduzida na década de 50 por Talairach, é um método invasivo de análise tridimensional da zona epilpeptogênica, baseado na técnica de implantação intracraniana de eletrodos de profundidade (EP). O advento das modernas técnicas de cirurgia guiadas por imagem revolucionaram a técnica de implantação dos EP. Objetivo: O objetivo deste artigo é discutir os princípios da E-EEG e sua evolução, desde a era Talairach até a era atual, da cirurgia guiada por imagem, e suas perspectivas futuras. Conclusões: Embora os princípios gerais da E-EEG tenham permanecidos intactos ao longo dos anos, a implantação de EP, que é a técnica cirúrgica que viabiliza este método, sofreu uma tremenda evolução ao longo das últimas três décadas devido ao advento das modernas técnicas de imagem, de sistemas de computação e das novas técnicas estereotáxicas. O uso de sistemas robotizados, a evolução constante das técnicas de imagem e computação e a utilização de EP com sondas para micro diálise associados a si, abre no futuro uma enorme perspectiva para a aplicação dos EP e da E-EEG, tanto para uso investigativo como terapêutico. A descoberta de novos alvos, em localizações profundas e a fabricação de eletrodos "inteligentes", poderá incrementar, num futuro próximo, a necessidade do uso deste método.Unitermos: Epilepsia, estereoeletroencefalografia, eletrodo profundo, cirurgia guiada por imagem. ABSTRACT Stereoelectroencephalography in the era of imaging guide surgeryIntroduction: The stereoelectroencephalography (SEEG), introduced by Talairach in 50', is an invasive method of tridimensional analysis of epileptogenic zone based on the intracranial placement of depth electrodes (DE). The advent of modern imaging guided surgery had a tremendous impact in DE implantation techniques. Objective: The aim of this article is to discuss the main principles of SEEG and its evolution along the years since Talairach era until the imaging guide surgery era, with its new perspectives. Conclusions: Although the main principles of SEEG have remained intact, the placement of depth electrodes (DE) which is the surgical technique that supports this method has suffered a tremendous evolution along the last three decades due the advent of the modern imaging, the computer systems and the new stereotactic techniques. The use of robotic, the new imaging and computed systems and the use of probes of micro dialise adaptated to EP opened a tremendous perspective to DE and SEEG application as an investigative and therapeutical method. The discovery of new targets in deep brain localization and the manufacturing of "smart" DE, can increment, in a near future, the number of indications to this method.

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SEEG‐guided RF Thermocoagulation of Epileptic Foci: Feasibility, Safety, and Preliminary Results

Cited by 142 publications

References 38 publications

Seizure freedom after intracranial electrode implantation in pharmacoresistant epilepsy

Seizure freedom after intracranial electrode implantation in pharmacoresistant epilepsy

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

Estereoeletroencefalografia na era da cirurgia guiada por imagem

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