Stereotactic bilateral transfrontal minimal radiofrequency thermocoagulation of the amygdalohippocampal complex for bilateral medial temporal lobe epilepsy: a retrospective study of 12 patients

Abstract

Background. Some patients with temporal lobe epilepsy have bilateral discharges and a few have bilateral medial temporal sclerosis. Stereotactic bilateral radiofrequency thermocoagulation (RFTC) of the amygdalohippocampal complex can terminate seizures or reduce seizure severity in patients with bilateral medial temporal lobe epilepsy (BMTLE). Aim. To explore the safety and efficacy of bilateral transfrontal minimal RFTC of the amygdalohippocampal complex for the treatment of BMTLE. Methods. A total of 12 BMTLE patients were treated with bilateral transfrontal minimal RFTC of the amygdalohippocampal complex under limited coagulations. The volumes of coagulated lesions were less than 0.6 cm3 Clinical outcomes were evaluated using Engel's classification, the Liverpool Seizure Severity Scale (LSSS) 2.0, Wechsler Adult Intelligence Scale‐Revised (WAIS‐R), and Wechsler Memory Scale‐Revised (WMS‐R). Quality of life (QOL) was evaluated using the 36‐item Short Form Health Survey (SF‐36). Results. Of the 12 patients, five (42%) were assessed as Engel Class I during 12–62 months of follow‐up. LSSS scores declined sharply compared with the baseline of patients not in the seizure‐free category. Functions of memory and intelligence declined transiently without statistical significance (p>0.05) immediately after surgery, but improved significantly (p<0.05) six months later. The qualities of life improved except vitality. Conclusion. Bilateral transfrontal minimal RFTC of the amygdalohippocampal complex may terminate seizures or reduce seizure severity in patients with BMTLE. Under limited coagulations, neuropsychological function was not affected but improved along with seizure control.

Stereo‐electroencephalography‐guided radiofrequency thermocoagulation in patients with focal epilepsy: A systematic review and meta‐analysis

“…Several clinical studies evaluating LiTT have been published over the past years. Most of them reported the seizure outcome following LiTT in patients with MTLE . Although the seizure‐free rate varied across the series, the results following LiTT might be close to those reported in patients who undergo selective hippocampo‐amygdalectomy .…”

Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta‐analysis of outcomes

“…Of the 373 reviewed abstracts and studies, a total of 37 studies dealing with thermal ablation (18 MRgLITT studies and 19 RFA studies) were closely analyzed. Finally, 13 studies dealing with MRgLITT [21][22][23][24][25][26][27][28][29][30][31] and six dealing with RFA [32][33][34][35][36] were included (Figure 1). For ATL and sAHE, four RCTs 4,37-39 and 20 comparative studies [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] were included.…”

“…60 Zhao et al reported on 12 patients with bilateral ablation of the temporal lobes and could demonstrate a significant improvement at the group level in all scales of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) as well as the Wechsler Memory Scale-Revised, except the delayed recall. 32 In contrast, Lee et al could not detect a significant difference in WAIS-R at 6 months after RFA. 61 Neuropsychological data at an individual level were found in six of the open surgery studies and were summarized.…”

Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC)

“…A recent meta-analysis that included 6 studies [19,22,24,26,27,32] and a total of 296 patients found a seizure-free rate of 23% and a responder rate of 58% one year after the SEEG-guided RF-TC, responders being defined as those with 50% or greater reduction in seizure frequency as compared to the pre-procedure period [30]. At the study level, meta-regression failed to identify factors impacting the seizurefree rate, including the number of RF-TC.…”

“…Alongside surgical advances in conventional epilepsy surgery, stereotactic lesioning has emerged as an alternative when surgery is not an option. Several stereotactic approaches have been developed, including radiosurgery [6], Laser Interstitial Thermotherapy (LiTT) [7][8][9][10][11][12][13][14][15], High Intensity Focal Ultrasound (HIFU) [16,17], and SEEG-guided Radiofrequency Thermo-Coagulation (SEEG-guided RF-TC) [18][19][20][21][22][23][24][25][26][27]. The present review focuses on the latter, which aims at coupling SEEG investigation with RF-TC stereotactic lesioning directly through the recording electrodes.…”