Network radiofrequency ablation for drug resistant epilepsy

Area of Science:

• Neurosurgery
• Epileptology
• Medical Devices

Background:

• Drug-resistant focal epilepsy often requires surgical intervention.
• Standard resections offer better seizure control than radiofrequency ablation (RFA) alone.
• RFA is typically guided by stereoencephalography (sEEG) to target the seizure onset zone (SOZ).

Purpose of the Study:

• To evaluate the efficacy and safety of an expanded RFA strategy targeting both the SOZ and seizure spread regions.
• To assess the potential of 'network RFA' to improve seizure outcomes in focal epilepsy.

Main Methods:

• Network radiofrequency ablation (RFA) was performed in four patients with drug-resistant focal epilepsy.
• sEEG was used to identify both the seizure onset zone (SOZ) and seizure spread regions.
• Patients were assessed for seizure control (Engel classification) and neurological deficits.

Main Results:

• Two patients achieved Engel IB outcomes, and two achieved Engel III outcomes.
• Median follow-up was 25.5 months (range 17-35 months).
• No permanent neurological deficits were reported. Etiologies included polymicrogyria and malformations of cortical development (MCD).

Conclusions:

• Network RFA demonstrates potential as a safe and effective treatment for focal epilepsy, particularly in cases with extensive malformations of cortical development (MCD).
• This approach may offer an alternative for patients unsuitable for standard resection.
• Further research is warranted to validate these findings in larger cohorts.