Stereoelectroencephalography-guided radiofrequency thermocoagulation for drug-resistant epilepsy: A meta-analysis

In patients with focal drug-resistant epilepsy (DRE), resective epilepsy surgery correlates with high rates of remission. However, in cases where the epileptic region is deemed surgically inaccessible, or when it involves a complex network, stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-RFTC) might be an alternative therapeutic strategy. However, most of the available evidence is limited to small observational studies. An updated meta-analysis is warranted to provide a comprehensive assessment of SEEG-RFTC in patients with DRE.

Databases were searched until September 9, 2023 to identify published studies reporting on the effectiveness of SEEG-RFTC in patients with DRE. The primary outcomes of interest were the 1-year seizure-freedom rate and response rate (50% seizure frequency decrease from baseline). These outcomes were pooled using the inverse variance and a random-effects model.

We screened 182 articles and included 16 retrospective cohort studies. A total of 437 unique patients from 12 nonoverlapping cohorts were analyzed for seizure and complication outcomes. The pooled seizure-free rate after 1 year was 37.8% (95% confidence interval [CI] = 24.7%-50.8%), whereas the seizure response rate after 1 year was 69.7% (95% CI = 52.7%-86.7%). There was high heterogeneity among the included studies. Subgroup analysis revealed that patients with nodular heterotopia achieved higher rates of seizure freedom (57.1%, 95% CI = 38.8%-75.5%) compared to those with cortical dysplasia (CD) and magnetic resonance imaging-negative conditions. Furthermore, hippocampal sclerosis patients exhibited higher seizure freedom rates (66.7%, 95% CI = 49.8%-83.5%) than those with CD (12.0%, 95% CI = .0%-24.7%).

SEEG-RFTC might be an effective therapeutic option for seizure control in patients with DRE who undergo SEEG for DRE workup. The role of SEEG-RFTC as a potential adjunct therapy to laser interstitial thermal therapy or surgical resection should be explored. This study highlights the need for well-designed clinical trials to compare SEEG-guided RFTC with other therapeutic modalities.