RF-ablation in periventricular heterotopia-related epilepsy

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Drug-resistant focal epilepsy frequently occurs in patients with gray matter nodular heterotopia (NH).
• NH-related epileptogenicity involves complex networks, often necessitating invasive EEG for localization.
• Surgical interventions for NH epilepsy can be limited by lesion laterality and risk of neurological deficits.

Purpose of the Study:

• To evaluate radiofrequency thermocoagulation (RFTC) as a primary treatment for NH-related epilepsy.
• To assess the efficacy and safety of SEEG-guided RFTC in diverse NH presentations.
• To compare RFTC outcomes with traditional surgical approaches.

Main Methods:

• Stereotactic electroencephalography (SEEG) for precise localization of epileptogenic zones.
• Radiofrequency thermocoagulation (RFTC) using implanted SEEG electrodes for targeted ablation.
• Analysis of seizure outcomes and neurological deficits post-RFTC.

Main Results:

• RFTC demonstrated excellent seizure control in initial unilateral NH cases.
• Promising results were observed in extended unilateral and bilateral NH cases with SEEG guidance.
• A reported series showed 67% sustained seizure freedom, though complex cases (NH with other malformations) had less favorable outcomes.

Conclusions:

• SEEG-guided RFTC is a safe and effective first-line treatment for NH-related epilepsy.
• RFTC offers a viable alternative for patients unsuitable for traditional resective surgery.
• Electrode planning for SEEG should consider potential RFTC targets for comprehensive treatment.