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SEEG-guided radiofrequency coagulation (SEEG-guided RF-TC) versus anterior temporal lobectomy (ATL) in temporal lobe epilepsy

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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.

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Acknowledgements

We thank Dr Philip Robinson (DRCI, Hospices civils de Lyon, France) for help in manuscript preparation and English editing.

Funding

This study was not sponsored.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Hospices Civils de Lyon, Neurology and Neurosurgery Hospital Pierre Wertheimer, 59, Bd Pinel, 69677, Bron, France

    Alexis Moles, Marc Guénot & Pierre Bourdillon

  2. Department of Neurosurgery, Nantes University Hospital, Nantes, France

    Alexis Moles

  3. University of Nantes, Nantes, France

    Alexis Moles

  4. University of Lyon, Université Claude Bernard Lyon 1, Lyon, France

    Marc Guénot, Sylvain Rheims, Sebastien Boulogne & Pierre Bourdillon

  5. NEUROPAIN Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS, Université Claude Bernard Lyon 1, 5292, Lyon, France

    Marc Guénot

  6. Department of Functional Neurology and Epileptology, Neurology and Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France

    Sylvain Rheims, Hélène Catenoix, Sebastien Boulogne & Jean Isnard

  7. TIGER, Neuroscience Research Center of Lyon, INSERM U1028, CNRS, Université Claude Bernard Lyon 1, 5292, Lyon, France

    Sylvain Rheims

  8. Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France

    Julien Berthiller

  9. Department of Sleep, Epilepsy and Pediatric Clinical Neurophysiology, Hospices Civils de Lyon, Lyon, France

    Alexandra Montavont & Karine Ostrowsky-Coste

  10. Sorbonne Université, Paris, France

    Pierre Bourdillon

  11. Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France

    Pierre Bourdillon

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  1. Alexis Moles
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Correspondence to Alexis Moles.

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Moles, A., Guénot, M., Rheims, S. et al. SEEG-guided radiofrequency coagulation (SEEG-guided RF-TC) versus anterior temporal lobectomy (ATL) in temporal lobe epilepsy. J Neurol 265, 1998–2004 (2018). https://doi.org/10.1007/s00415-018-8958-9

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  • DOI: https://doi.org/10.1007/s00415-018-8958-9

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