Observation on the long-term efficacy of stereoelectroencephalography-guided radiofrequency thermocoagulation in the treatment of mesial temporal lobe epilepsy
Objective To explore the long-term effects of stereoelectroencephalography(SEEG)-guided radiofrequency thermocoagulation(RFTC)in patients with mesial temporal lobe epilepsy.Methods A retrospective analysis was performed on the clinical data of 23 patients with mesial temporal lobe epilepsy who were treated with SEEG-guided RFTC at the Neurosurgery Department of the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from April 2019 to December 2020 and with a follow-up time of 36 months.All patients underwent a complete preoperative epilepsy evaluation of stage Ⅰ and stage Ⅱ,and an electrode placement plan was comprehensively designed based on symptomatology,electroencephalography,multimodal imaging and other data.The cases were determined to be mesial temporal lobe epilepsy,and SEEG electrodes were used for conformal damage.Outpatient or telephone follow-up was conducted at 3,6,12,24,and 36 months after surgery.The modified Engel classification was used to evaluate the surgical efficacy.Modified Engel grade Ⅰ and Ⅱ were considered effective in RFTC treatment.During the follow-up period,if the patient underwent anterior temporal lobectomy surgery,the case was recorded as ineffective RFTC treatment.According to whether habitual seizures were induced by electrical stimulation before RFTC surgery,patients were divided into a group with habitual seizures induced and a group without habitual seizures induced.The frequency of epileptic seizures before and after surgery was compared between the two groups.Results All 23 patients underwent successful RFTC surgery without obvious adverse events.At the 3-month follow-up after surgery,14 cases(60.9％)were classified as Engel grade Ⅰ(60.9％),8(34.8％)as grade Ⅱ,and 1(4.3％)as grade Ⅳ.The effective rate of RFTC treatment was 95.6％(22/23).Among them,all 14 patients with modified Engel classification grade Ⅰ had habitual seizures induced by preoperative electrical stimulation.During the follow-up period,9 patients underwent anterior temporal lobectomy.The follow-up time after anterior temporal lobectomy[M(Q1,Q3)]was 26(18,30)months,and 8 patients reached modified Engel classification grade Ⅰa and 1 case was grade Ⅱ.As of the last follow-up,the effective rate of RFTC treatment was 13.0％(3/23).Compared with the group in which habitual seizures were induced(17 cases)and the group in which habitual seizures were not induced(6 cases),there was no statistically significant difference in the frequency of epileptic seizures before surgery[M(Q1,Q3):6.00(5.00,10.00)times/month vs.8.00(5.25,17.50)times/month,P=0.804].The group with induced habitual seizures had a lower frequency of epileptic seizures 3 months after surgery than the group without induced habitual seizures[M(Q1,Q3):0.17(0,4.00)times/month vs.5.00(2.50,10.50)times/month,P=0.022].Compared with those before surgery,the frequency of epileptic seizures in both groups decreased 3 months after surgery(both P＜0.05).Conclusions The short-term effective rate of SEEG-guided RFTC in the treatment of mesial temporal lobe epilepsy is higher,and the effect is better in patients with habitual seizures induced by preoperative electrical stimulation.However,as time goes by,the effective rate decreases,and patients who relapse and need anterior temporal lobectomy can still achieve good therapeutic effect.
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