Seizure Freedom After Limited Hippocampal Radiofrequency Thermocoagulation

Surgical interventions are often used for freedom from seizure in patients with drug-resistant mesial temporal lobe epilepsy. A patient with seizure foci in the left mesiotemporal region underwent limited-size stereotactic radiofrequency thermocoagulation (RF-TC) over the left hippocampus.

A 37-year-old woman with febrile convulsion in her childhood was admitted to our neurologic department with complex partial seizure with secondary generalization. Electroencephalography showed epileptogenic focus mainly from the left mesiotemporal region, and magnetic resonance imaging confirmed a left hippocampal atrophy. Because of failure to control seizure after use of several antiepileptic drugs, drug-resistant mesial temporal lobe epilepsy was diagnosed. RF-TC was done in the left hippocampus. Unique features of our technique include intraoperative electroencephalography recordings directly from electrodes on the left hippocampus, an aura sensation provoked during the low-temperature test thermocoagulation, and therapeutic thermocoagulation performed via a Radionics radiofrequency lead. In the 16-week period following the surgery, the patient experienced no seizure attacks and no significant postoperative adverse effects or memory impairments. Compared with other reports using RF-TC, our case demonstrates a 1-step minimally invasive surgery that reduces hippocampal volume loss, shortens the length of hospital stay, decreases the occurrence of postoperative infection, and achieves good outcomes for epilepsy control.

Favorable seizure control was achieved with minimally invasive RF-TC. Further use of this technique is warranted in cases of drug-resistant mesial temporal lobe epilepsy.