Radiofrequency thermocoagulation for the treatment of refractory focal status epilepticus

This case study reports the first documented use of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC) to treat refractory status epilepticus (RSE). A 33-year-old woman with drug-resistant epilepsy and recurrent RSE underwent SEEG to define her epileptogenic zone. A new RSE started shortly before and continued during the SEEG exploration, being unresponsive to multiple antiseizure medications, vagal nerve stimulation, and corticosteroid therapy. SEEG-signal quantification based on ictal biomarkers, that is, epileptogenicity index and connectivity epileptogenicity index, identified the epileptogenic zone network (EZN) within the mesial prefrontal, premotor, and parietal cortex, with major implication of the anterior-middle and posterior cingulate cortex. RFTC was performed on SEEG-identified targets within the EZN and resulted in rapid cessation of electroclinical seizure activity and full recovery from motor deficits. Seizure frequency remained reduced by over 90% at 4 months post-procedure. This case highlights the potential of RFTC as a possible therapeutic option for RSE by directly disrupting critical network nodes responsible for seizure generation and propagation. The findings also suggest a broader role of SEEG not only for diagnostic purposes but also for the therapeutic management of refractory seizures, including status epilepticus.