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Systematic review and patient-level meta-analysis of radiofrequency ablation for medically refractory epilepsy: Implications for clinical practice and research

Published:October 03, 2022DOI:https://doi.org/10.1016/j.seizure.2022.10.003

      Highlights

      • Twenty studies with 360 patients were analyzed.
      • Mesial temporal structures were the most common target.
      • New neuro-deficits developed in 10% (2% permanent).
      • Engel I/II class outcome was achieved in 62% of cases.
      • Higher lesion number, lesional MRI, monopolar RF-TC predicted favorable response.

      Abstract

      Background

      Radiofrequency thermocoagulation (RF-TC) is a minimally invasive procedure for the treatment of epileptic foci. The aim of this study is to review available evidence on the safety and efficacy of RF-TC for medically refractory epilepsy.

      Methods

      A comprehensive literature search (Pubmed/Medline, EMBASE, Cochrane) was conducted for studies with patient-level data on RF-TC for medically refractory epilepsy. Seizure outcome (Engel classification) at last follow-up comprised the primary endpoint. New temporary or permanent post-procedural neurological deficits were the secondary endpoints.

      Results

      A total of 20 studies (360 patients) were analyzed. Median age at the time of intervention was 29 years (interquartile range (IQR): 21–37) and 57% were males. A lesional MRI was noted in 59% of patients. Median duration of postoperative follow-up was 24 months (IQR: 11–48). The median number of RF-TC lesions per patient was 11 (IQR: 6–19), with bipolar ablation (i.e. between two contiguous contacts) being the most common method (n = 244, 68%). The most common RF-TC location was the mesial temporal structures, without (34%) or with (7%) the temporal neocortex, followed by the insula (13%) and the frontal lobe (12%). Multilobar targets were lesioned in 11% of patients. New neurological deficits developed in 10% of patients (2% remained permanently), with the most common being motor deficits. Among patients with at least 12 months of follow-up (n = 267, 74% of overall cohort), a favorable seizure outcome (Engel I/II class) was achieved in 62% of cases. Patients with a favorable seizure outcome were significantly more likely to have a lesional MRI (71% vs 43% 51%, p < 0.001), have a higher number of RF ablations (15 [IQR 8–31] vs 9 [IQR 4–14], p < 0.001), and undergo monopolar RF-TC (50% vs 30%, p = 0.002).

      Conclusion

      Current evidence supports the promising safety and efficacy profile of RF-TC for medically refractory epilepsy. Randomized controlled trial data are needed to further establish the role of this intervention in preoperative discussions with patients and their families.

      Keywords

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