Systematic review and patient-level meta-analysis of radiofrequency ablation for medically refractory epilepsy: Implications for clinical practice and research

Radiofrequency ablation during stereoelectroencephalography: from diagnostic tool to therapeutic intervention. Illustrative case

“…Ablation parameters were carefully ascertained from multiple reports in the literature, spanning in vitro and in vivo studies, confirming that reproducible lesions can be generated around 78°C-82°C over an average treatment duration of anywhere from 10 to 60 seconds, depending on the RF generator used. [1][2][3][4][5][6][7][8] Consistent with other studies, no coagulation was performed in close proximity (< 2 mm) of any major vascular structures. 9,10 Care was taken to ensure the temperature of the probe had fallen to less than 40°C prior to sliding it back for each successive treatment.…”

“…In a recent systematic review of 20 studies (with a total of 360 patients undergoing RFTC for epilepsy), a favorable seizure outcome (defined as Engel class I/II) was achieved in 62% of patients with at least 12 months of follow-up. 8 From this same study, favorable prognostic factors included lesional MRI, a higher number of RF ablations performed, and monopolar RFTC. Prior representative case series specifically highlighting sEEG-guided RFTC are perhaps less optimistic, with seizure-free rates of 15%–23% and responder rates of 41%–67% (reportedly highest in patients with gray matter nodular heterotopia), with an overarching complication rate of approximately 2.5%.…”

“… 21 Various coagulation parameters have been proposed in the literature, varying from center to center, contingent on the RF generator and electrodes used. 7 , 8 , 22 On the basis of a growing literature around this topic, therapeutic lesions are reportedly achieved by an incremental empirical increase in power until the measurable lead impedance abruptly rises (with a concomitant fall in current), often accompanied by a self-reported audible sound of “crackling” or “popping” experienced by the patient when performed awake. 23 These settings were validated in vitro and in vivo using egg white and rabbit models, capturing lesional effects using a 50-V, 120-mA current for a 45- to 60-second duration, approximating temperatures nearing 78–82°C.…”

Multimodal approach leads to seizure-freedom in a case of highly refractory drug-resistant focal epilepsy

“…The 2 weeks of seizure freedom following ablation motivated the eventual resective surgery. Radiofrequency ablation is a minimally invasive technique that leads to small lesions, which can provide diagnostic and therapeutic benefit [13] . While the long-term seizure outcomes from radiofrequency ablation are less favorable than resective surgery, one study reported 41% of patients were responders at 12 months with some patients remaining seizure free [4] .…”

Letter to the Editor regarding “Management of epilepsy in older adults: A critical review by the ILAE Task Force on Epilepsy in the Elderly”

“…6,7 In higher risk surgical candidates, less invasive treatment options, namely ablative (laser or radiofrequency) and neuromodulation therapies (deep brain, responsive, or vagus nerve stimulation), have emerged as safer yet promising alternatives, and their efficacy in the older population remains to be determined in future work. [8][9][10][11] Finally, apart from the evaluation of quality of life and neurocognitive outcomes, another important parameter that will further consolidate the role of surgery is a formal costevaluation analysis, especially in the "mid-old" and "old-old" groups. Using cost data from Vizient, we estimated the mean hospital costs at $31 977 in the 50-59 group, $34 586 in the 60-69 group, and $40 153 in the 70+ group.…”