Study on the correlation between the degree of damage and efficacy of radiofrequency thermocoagulation in the treatment of epilepsy caused by focal cortical dysplasia type Ⅱ
Objective To explore the efficacy of stereoelectroencephalography(SEEG)electrode-mediated radiofrequency thermocoagulation(RFTC)in the treatment of epilepsy caused by focal cortical dysplasia(FCD)type Ⅱ and the correlation between the degree of damage and the efficacy.Methods The clinical data of 31 patients with drug-refractory epilepsy caused by FCD type Ⅱ who were treated with SEEG electrode-mediated RFTC at the Neurosurgery Department of Guangdong Sanjiu Brain Hospital from October 2017 to November 2021 were retrospectively analyzed.The FCD lesions of 31 patients were located in the frontal lobe in 13 cases,the central area in 17 cases,and the parietal lobe in 1 case.The postoperative complications and modified Engel classification were documented.The efficacy of seizure control was evaluated by the degree of seizure frequency reduction.Based on the preoperative head MRI fluid-attenuated inversion recovery(FLAIR)sequence and postoperative head MRI 3D T1-weighted imaging,MATLAB software was used to measure the volume of the three-dimensional module of each lesion and damaged lesion.The volume of the spatial overlap between preoperative FCD lesions and post-RFTC damaged lesions was defined as the effective damaged volume of the lesions,and its ratio to the preoperative FCD lesions was the degree of lesion damage.Patients were divided into sufficiently damaged group and insufficiently damaged group according to whether the degree of lesion damage was ≥ 40％,and the proportion of Engel grade Ⅰ patients in the two groups was compared.The Spearman method was used to analyze the correlation between the degree of lesion damage and the efficacy of seizure control.Results The RFTC surgeries of 31 patients were successfully completed,and the number of damaged targets[M(Q1,Q3)]was 20(14,26).Eight patients with lesions located in the central area experienced temporary mild decrease in muscle strength of the contralateral limb after RFTC treatment.The follow-up time[M(Q,,Q3)]of 31 patients was 38(7,50)months.As of the last follow-up,there were 17 cases(54.8％)of Engle classification grade Ⅰ,3 cases(9.7％)of grade Ⅱ,6 cases(19.4％)of grade Ⅲ,and 5 cases(16.1％)of grade Ⅳ.The degree of seizure frequency reduction[M(Q,,Q3)]was 100％(58％,100％).Eight patients(25.8％)underwent further surgery for resection of lesions and epileptogenic zones due to poor efficacy,and no recurrence occurred after surgery.The volume of FCD lesions[M(Qt,Q3)]in 31 patients was 1 735(1 176,2 857)mm3.The volume of damaged lesions[M(Q1,Q3)]in 31 patients was 1 436(1 255,2 607)mm3.The effective damage volume was 591(410,932)mm3.The damage degree of the lesion was 37％(30％,57％).Spearman correlation analysis results showed that the degree of lesion damage was positively correlated with the degree of seizure frequency reduction(Spearman correlation coefficient:0.61,P＜0.001).Compared with the insufficiently damaged group(18 cases),the sufficiently damaged group(13 cases)had a higher proportion of Engle grade Ⅰpatients(12/13 vs.5/18),and the difference was statistically significant(P＜0.001).Conclusions RFTC mediated by SEEG electrodes is safe and effective in the treatment of epilepsy caused by FCD type Ⅱ.Patients with higher degree of lesion damage have better seizure control efficacy.
Drug resistant epilepsyMalformations of cortical development,group ⅡStereo-taxic techniquesTreatment outcomeRadiofrequency thermocoagulation
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