Clinical Value Of SEEG-radiofrequency Destruction In The Treatment Of Refractory Epilepsy

ObjectiveTo investigate patients with Medically intractable epilepsy(MIE),After radiofrequency damage guided by Stereotactic electroencephalogram(SEEG),The improvement of seizures provides an objective clinical basis for minimally invasive treatment of MIE.MethodsWe searched 24 patients who were diagnosed with MIE from March 2017 to October 2018 and who were in our department SEEG-RF-TC.The patients were followed up for 6-24 months.The number of seizures and the incidence of postoperative complications were recorded.The effectiveness and safety of SEEG-RF-TC in the treatment of MIE was evaluated by statistical methods.Compare the seizure frequency of patients before and after SEEG-RF-TC surgery,the non-normal distribution of measurement data,using nonparametric test,ie rank sum test.Among them,P<0.05 was statistically significant.ResultA total of 24 patients(male 14,female 10)were enrolled in this study,aged 7 to 53 years(mean 21.6+11.4 years).The patient had a history of epilepsy from 1 to 28 years(mean 11.1 ± 8.9).Eight of the 24 patients had a definite cause,including 6 cases(25%)of hypoxia and asphyxia at birth,1 case(4.17%)with febrile seizures,1 case(4.17%)of traumatic brain injury,and 2 cases of family history of epilepsy.(8.33%).Seventeen patients were eligible for re-surgical resection,Four of them underwent surgical resection after SEEG thermocoagulation(6-10 months,mean 7±2 months).Seven patients who were unsuitable for surgical resection were followed up for 6-20 months with an average of 15.8±5.6 months.Twelve patients(50%)had a reduction in seizures of more than 50%,11 of whom were over 80%,of which 6 had complete remission and no recurrence occurred after surgery.There was no significant reduction in seizures in 10 patients.No patient had an increased number of postoperative episodes.Fourteen patients(58.3%)had an improvement in seizures after SEEG lesions.Six patients had complete disappearance of postoperative seizures and no clinical onset.The follow-up period was 6-26 months after surgery,with an average of 12.3+7.8 months.Among the patients who were not suitable for surgical resection(7 cases),4 of 6 cases had a more than 80%seizure,and 3 of them had complete disappearance of postoperative seizures.ConclusionStereotactic EEG technology was previously only used for diagnosis,and SEEG-RF-TC has made SEEG therapeutic.In fact,the use of SEEG electrodes for multi-target RF thermocoagulation also provides us with a unique opportunity to explore epileptic networks.In addition,the therapy has fewer complications,minimally invasive and reversible,and has no long-term side effects,especially for cognitive function.It can be used to treat lesions close to important functional areas of the cortex(such as sports or linguistic areas),or areas that are difficult to reach with conventional surgery(such as the insular cortex).For patients who are not at risk for routine surgical craniotomy or surgery,SEEG-RF-TC is a relatively safe treatment option with a relatively high benefit.Seven of the 24 patients in this subject belonged to this condition,4 of whom benefited from the treatment,4 of which had a reduction in seizure frequency of more than 80%,and 3 had no seizures at all.In these cases,SEEG-RF-TC has been shown to be a safe and effective treatment option,especially in comparison to VNS,DBS,multiple subdural transections,and other palliative treatments such as corpus callosum.On the contrary,for patients with cortical resection,SEEG-RF-TC is not as good as surgical resection.In fact,4 patients in this group underwent routine resection after radiofrequency ablation.All postoperative outcomes were EngelI.The results showed that SEEG-RFTC is not a substitute for resection surgery.For patients who are eligible for routine surgery,we should not recommend SEEG-RF-TC,especially for patients undergoing medial temporal resection.The best efficacy of SEEG-RF-TC was found in cases of MIE caused by focal cortical dysplasia and difficult to remove.Indeed,in MIE patients with cortical developmental abnormalities,14 patients(58.3%)had a reduction in seizure frequency of more than 50%,and 6 of them were followed up for 6-26 months without seizures.It is well known that in patients with epilepsy caused by malformation of the cortex,the completeness of the resection of the lesion is highly consistent with the degree of control of epilepsy.For such patients,we now prefer to increase the number of implanted electrodes in the lesion so that there are more therapeutic targets available for subsequent RF thermocoagulation..