Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation in Drug-Resistant Focal Epilepsy
DOI:
https://doi.org/10.5281/zenodo.22310453Keywords:
Stereoelectroencephalography, Radiofrequency thermocoagulation, Drug-resistant epilepsy, Hypothalamic hamartoma, Epilepsy surgeryAbstract
Background: Stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) turns diagnostic depth
electrodes into a therapeutic tool, delivering small lesions along the epileptogenic zone without further craniotomy.
Objective: To synthesise evidence on SEEG-guided RF-TC across epileptogenic-zone locations, safety, and its relationship to
resective surgery. Methods: Narrative review of case series, cohort studies, a systematic review and meta-analysis, and technique papers on SEEG methodology and RF-TC mechanism. Findings: Pooled seizure freedom after RF-TC is modest, roughly 20-25%, with low complication rates, generally under 3%. Outcomes vary by target: hypothalamic hamartoma series report long-term freedom of 50-70%, approaching curative results, while insular and temporal targets fare less well than resection. Repeat thermocoagulation recovers seizure control in a meaningful subset after initial failure. Conclusions: RF-TC fills a niche between medical therapy and resection: modest but real efficacy, low morbidity, and repeatability, best framed as palliative for most cortical epilepsies and potentially curative for hypothalamic hamartoma.
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