| Objective: High frequency oscillations(HFOs)can help to determine the epileptogenic region and epileptogenic network in patients with refractory epilepsy,and guide surgical treatment.Studies have shown that patients who remove more of the brain areas that produce HFOs may have a better prognosis.However,this indicator is still controversial,with different studies showing inconsistent results.In response to this controversy,a meta-analysis was conducted on the ratio of HFOs removed and patient prognosis to explore the correlation between HFOs and patient prognosis.Furthermore,radiofrequency thermocoagulation(RF-TC)and prognosis data of epileptic patients were used to further explore the short-term and long-term efficacy between RF-TC based on stereoelectroencephalogram(SEEG)HFOs analysis and the prognosis of epileptic patients,so as to provide basis for RF-TC therapy based on HFOs analysis.Methods: Prospective and retrospective studies using HFOs analysis to guide surgical treatment of epilepsy were included for meta-analysis.Patients in the included studies were grouped according to the ratio of HFOs removed and were divided into four groups: FR was completely removed(C-FR),Ripple was completely removed(C-Ripple),FR was mostly removed(P-FR),and Ripple was mostly removed(P-Ripple).The prognosis of patients was compared within the group to explore the correlation between the HFOs removed ratio and the prognosis of patients.Further retrospective analysis was conducted on 14 patients with refractory epilepsy who underwent SEEG monitoring and received RF-TC therapy.The patients were divided into non-seizure group(NS group)and seizure group(S group)according to the prognosis of the patients within 3 months and 6 months after RF-TC.According to the last follow-up time of patients,the patients’ prognosis was evaluated according to Engel prognosis classification,and they could be divided into good prognosis group(G group)and poor prognosis group(P group).The automatic detection algorithm of Matlab was used to calculate the incidence of HFOs in each montage of included patients,and the fitting curve of the incidence of HFOs was used to formulate the threshold of HFOs in order to delimit the HFOs region.To explore the relationship between the proportion of RF-TC guiding HFOs based on SEEG and the postoperative effect of epilepsy.Results: A total of 9 studies were included in the meta-analysis,and intra-group meta-analysis was performed.In the group of C-FR,patients with completely removed FR had better prognosis than those with incompletely removed FR(OR=6.62,95%CI:3.10-14.15;P<0.00001).In the group of C-Ripple,patients with completely removed Ripple had significantly better prognosis than those with incompletely removed FR(OR = 4.45,95%CI:1.33-14.89;P=0.02).In the group of P-FR,patients with most FR removed had better prognosis than those mostly FR untouched(OR=6.23,95%CI:2.04-19.06;P=0.001).In the group of P-Ripple,the patients of most Ripple removed had a significantly better prognosis than those mostly Ripple untouched(OR=8.14,95%CI:2.62-25.33;P=0.0003).Retrospective analysis of the relationship between RF-TC and curative effect in 14 patients with epilepsy showed that the seizure-free rate within 3months after RF-TC was 71.4%(10/14),and the seizure-free rate within 6months after RF-TC was 57.1%(8/14).Within 3 months after RF-TC,the thermal coagulation rate of FR region in NS group was significantly higher than that in S group(t=2.704,P=0.020).Within 6 months after RF-TC,the thermal coagulation rate of Ripple region in NS group was significantly higher than that in S group(t=3.389,P=0.005).After RF-TC,the prognosis was evaluated according to the total follow-up time of patients,and the seizure-free rate was42.9%(6/14).After RF-TC,the thermal coagulation rate of Ripple region in group G was significantly higher than that in group P(t=2.260,P=0.043).However,there was no significant difference in the thermal coagulation rate of FR region between group G and group P after RF-TC(t=1.604,P=0.135).Among the 14 cases,the incidence of short-term neurological dysfunction was13.3%,and permanent neurological dysfunction,intracranial infection,intracranial hemorrhage,electrode device failure and other conditions did not occur.According to the last follow-up time of patient’s prognosis,further calculation of the efficacy of Ripple and FR in predicting RF-TC in prognosis:Specificity Ripple= 83.3%CI [36 99%],Sensitivity Ripple= 87.5%CI [47 99%],Negative prediction Ripple= 83.3%CI [36 99%],Positive prediction Ripple=87.5%CI [47 99%].Specificity FR=66.7% CI[24 94%],Sensitivity FR=75%CI[36 96%],Negative prediction FR=66.7% CI[24 94%],Positive prediction FR=75% CI[36 96%].Conclusion: HFOs plays an important role in guiding the surgical resection of epilepsy patients.If the FR region and Ripple region can be removed in a wider range,the postoperative efficacy of patients will be improved.Using the fitted curve helps to set the threshold of the HFOs region,thus assisting in the localization of the epileptogenic zone,and verifies the role of HFOs in the division of the epileptogenic zone.HFOs is highly correlated with the prognosis of RF-TC treatment in patients with epilepsy.In short-term efficacy of RF-TC,if the Ripple region and FR region of thermocoagulation can be wider,patients are expected to obtain better prognosis.In long-term efficacy of RF-TC,if the Ripple region of thermocoagulation can be wider,patients are expected to obtain better prognosis.It provides an effective basis for RF-TC treatment based on SEEG-HFOs.Seeg-guided RF-TC can be used as a diagnostic treatment for patients to verify the correctness of the hypothesis of epileptogenic zone and epileptogenic network,and has considerable effectiveness,which can be used as a treatment measure before resection. |
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