Alexis Moles1,2,3, Marc Guénot4,5,6, Sylvain Rheims5,7,8, Julien Berthiller9, Hélène Catenoix7, Alexandra Montavont10, Karine Ostrowsky-Coste10, Sebastien Boulogne5,7, Jean Isnard7, Pierre Bourdillon4,5,11,12. 1. Department of Neurosurgery, Hospices Civils de Lyon, Neurology and Neurosurgery Hospital Pierre Wertheimer, 59, Bd Pinel, 69677, Bron, France. pierre.bourdillon@neurochirurgie.fr. 2. Department of Neurosurgery, Nantes University Hospital, Nantes, France. pierre.bourdillon@neurochirurgie.fr. 3. University of Nantes, Nantes, France. pierre.bourdillon@neurochirurgie.fr. 4. Department of Neurosurgery, Hospices Civils de Lyon, Neurology and Neurosurgery Hospital Pierre Wertheimer, 59, Bd Pinel, 69677, Bron, France. 5. University of Lyon, Université Claude Bernard Lyon 1, Lyon, France. 6. NEUROPAIN Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS, Université Claude Bernard Lyon 1, 5292, Lyon, France. 7. Department of Functional Neurology and Epileptology, Neurology and Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France. 8. TIGER, Neuroscience Research Center of Lyon, INSERM U1028, CNRS, Université Claude Bernard Lyon 1, 5292, Lyon, France. 9. Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France. 10. Department of Sleep, Epilepsy and Pediatric Clinical Neurophysiology, Hospices Civils de Lyon, Lyon, France. 11. Sorbonne Université, Paris, France. 12. Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France.
Abstract
BACKGROUND: Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) is a super-selective procedure. Hippocampus has a limited volume and is widely accessible to SEEG so that SEEG-guided RF-TC could be an alternative to the anterior temporal lobectomy (ATL) in case of temporal lobe epilepsy (TLE) syndrome. OBJECTIVE: To compare seizure-free rate at 1-year follow-up between patients undergoing SEEG-guided RF-TC and patients undergoing ATL in TLE over a 15-year period. METHODS: All patients had a drug-resistant epilepsy and underwent SEEG after non-conclusive phase I investigations suspecting a TLE. Two groups were selected according to the procedure which the patients underwent (ATL or SEEG-guided RF-TC); TLE had to be confirmed by SEEG in the two groups. The primary outcome was seizure freedom at 1 year. The secondary outcome was response (at least 50% reduction of seizure frequency) at 1 year. In case of persistent seizures after SEEG-guided RF-TC, ATL was performed. RESULTS: A total of 21 patients underwent SEEG-guided RF-TC and 49 ATL. At 12 months, none of the patients of the SEEG-guide RF-TC group was seizure free, while 37 (75.5%) in the ATL group were so (p < 0.001). Ten patients (47.6%) were responders after 12 months of follow-up after SEEG-guided RF-TC; all patients in the ATL group who were seizure free were responders. CONCLUSION: SEEG-guided RF-TC is not as effective as ATL in TLE. As no memory impairment following SEEG-guided RF-TC was found, patients with dominant mesial involvement for whom hippocampectomy is not an option could benefit from the technique.
BACKGROUND: Stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) is a super-selective procedure. Hippocampus has a limited volume and is widely accessible to SEEG so that SEEG-guided RF-TC could be an alternative to the anterior temporal lobectomy (ATL) in case of temporal lobe epilepsy (TLE) syndrome. OBJECTIVE: To compare seizure-free rate at 1-year follow-up between patients undergoing SEEG-guided RF-TC and patients undergoing ATL in TLE over a 15-year period. METHODS: All patients had a drug-resistant epilepsy and underwent SEEG after non-conclusive phase I investigations suspecting a TLE. Two groups were selected according to the procedure which the patients underwent (ATL or SEEG-guided RF-TC); TLE had to be confirmed by SEEG in the two groups. The primary outcome was seizure freedom at 1 year. The secondary outcome was response (at least 50% reduction of seizure frequency) at 1 year. In case of persistent seizures after SEEG-guided RF-TC, ATL was performed. RESULTS: A total of 21 patients underwent SEEG-guided RF-TC and 49 ATL. At 12 months, none of the patients of the SEEG-guide RF-TC group was seizure free, while 37 (75.5%) in the ATL group were so (p < 0.001). Ten patients (47.6%) were responders after 12 months of follow-up after SEEG-guided RF-TC; all patients in the ATL group who were seizure free were responders. CONCLUSION: SEEG-guided RF-TC is not as effective as ATL in TLE. As no memory impairment following SEEG-guided RF-TC was found, patients with dominant mesial involvement for whom hippocampectomy is not an option could benefit from the technique.
Entities:
Keywords:
Drug resistant; Epilepsy surgery; Hippocampo-amygdalectomy; Mesio-temporal; Stereotactic lesioning
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