Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures
Nandini Mullatti1, Elisabeth Landre2, Charles Mellerio3
1Department of Clinical Neurophysiology, King's College Hospital, London, UK.
Epilepsia
|June 18, 2019
Summary
Stereotactic radiofrequency thermocoagulation (RFTC) can effectively treat refractory insular epilepsy. Lower RFTC volumes and accurate epileptogenic zone localization are key factors for successful seizure-free outcomes.
Area of Science:
- Neurosurgery
- Epileptology
- Radiology
Background:
- Refractory insular epilepsy presents a significant treatment challenge.
- Stereotactic radiofrequency thermocoagulation (RFTC) is an emerging therapeutic option.
Purpose of the Study:
- To identify factors associated with favorable outcomes in patients with refractory insular epilepsy treated with volume-based RFTC.
- To evaluate the efficacy and safety of RFTC for insular epilepsy.
Main Methods:
- Nineteen patients underwent volume-based RFTC using multimodal imaging (EEG-video, MRI, PET) and SEEG for epileptogenic zone (EZ) localization.
- The insular volume for thermocoagulation was precisely identified and destroyed with thermal lesions.
Main Results:
- A 53% seizure-free rate (Engel class IA) was achieved, with an 89% responder rate (Engel classes I-III).
- Factors for seizure-free outcome included FCD detection, localized EZ, and low RFTC volume/procedure count.
- Transient deficits occurred in 42% of patients, with most recovering fully.
Conclusions:
- RFTC, guided by accurate SEEG localization, can be curative for insular epilepsy.
- Optimal outcomes are linked to minimizing thermolesion volume, with ~2 cm³ offering a balance of efficacy and safety.
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