Dataset Information

Optimization and high-density array of stereoelectroencephalography-guided radiofrequency thermocoagulation for the treatment of pediatric tuberous sclerosis complex with epilepsy.

ABSTRACT:

Background

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome involved in many organ systems. At the same time, epilepsy is the most common manifestation and more than 50% of TSC patients present with intractable epilepsy. This study investigated the efficacy and safety of optimized and high-density stereoelectroencephalography (SEEG) guided radiofrequency thermocoagulation (RF-TC) in treating TSC-related epilepsy.

Methods

Nine TSC children with refractory epilepsy were treated with first-stage SEEG-Guided RF-TC, and four underwent second-stage-optimized high-density array of SEEG-Guided RF-TC. Patients' clinical data and postoperative outcomes were analyzed retrospectively.

Results

The patients' median age at surgery was 4 years and 2 month (range from 3 years and 5 month to 16 years and 7 month). The mean age at surgery was 6.7 years old. Eight in 9 (88.9%) patients achieved complete remission after the final operation at half-year follow-up. Of seven patients with final postoperative time beyond 1 year, 6 (85.7%) reached completely seizure-free. No severe or long-term neurologic impairment existed in all nine patients.

Conclusion

Optimized high-density array of SEEG-guided RF-TC is a safe and highly effective approach and can be an alternative application applied for TSC patients with refractory epilepsy.

SUBMITTER: Luo T

PROVIDER: S-EPMC8981452 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Publications

Optimization and high-density array of stereoelectroencephalography-guided radiofrequency thermocoagulation for the treatment of pediatric tuberous sclerosis complex with epilepsy.

Luo Tian T Wang Xinhua X Wang Ji J Zhao Rui R Li Hao H Zhou Yuanfeng Y Wang Yi Y

CNS neuroscience & therapeutics 20220115 5

<h4>Background</h4>Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome involved in many organ systems. At the same time, epilepsy is the most common manifestation and more than 50% of TSC patients present with intractable epilepsy. This study investigated the efficacy and safety of optimized and high-density stereoelectroencephalography (SEEG) guided radiofrequency thermocoagulation (RF-TC) in treating TSC-related epilepsy.<h4>Methods</h4>Nine TSC children with refr ...[more]

PMID: 35032101

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Project description:BackgroundStereoelectroencephalography (SEEG) has become a common diagnostic method in epilepsy surgery and is found to be safe for a wide range of clinical applications. SEEG combined with radiofrequency thermocoagulation (RF-TC) not only reveals the seizure onset zone by hypothesis, but also acts as a treatment option without any additional cost to institutions and patients. Thus, we analyzed the treatment of the SEEG-guided RF-TC.MethodsThis retrospective study analyzed seventeen epileptic patients treated with RF-TC between April 2019 and December 2020. All patients underwent a single round of SEEG-guided RF-TC treatment after more than three habitual seizures were recorded. The demographic characteristics of the patients were retrospectively reviewed. Outcomes were assessed using the Engel classification system.ResultsAll patients underwent SEEG-guided RF-TC without catastrophic functional damage. Follow-up data of all patients were complete. The number of contacts per patients where RF-TC was applied ranged from 9 to 43 (mean: 17.7±10.2). After RF-TC, the types of anti-epileptic drugs used reduced from 2.4±0.7 to 1.6±0.7. With RF-TC alone, four (23.5%) patients achieved Engel Ia, two (11.8%) patients achieved Engel Ib, one patient underwent resection without seizure at the 5-month follow-up, five patients had a relapse after 3-10 months of seizure freedom, and five patients had recurrence after 1 month. After RF-TC, six patients underwent secondary interventions followed by resection. Overall, 12 patients achieved Engel Ia or Ib, three patients achieved Engel IIa or IIb, and two patients achieved Engel IIIa. There were no Engel IV cases.ConclusionsSEEG-guided RF-TC performed in our institution was found to be a safe ablation procedure for the treatment of drug-resistant focal epilepsy. All patients experienced a reduction in the frequency of seizures after receiving RF-TC. RF-TC can be used as a palliative treatment option for patients with epilepsy who refuse surgery or cannot undergo resection surgery. Recurrence of focal epilepsy after RF-TC can be treated with resection surgery to achieve the seizure-free status.

Project description:BackgroundMesial temporal lobe epilepsy (MTLE) epileptiform discharges have been reported to arise from the hippocampus or the extrahippocampal medial temporal cortex, such as the amygdala, and then propagate to the temporal lobe cortex. The surgical ablation of which of these structures would result in a better postoperative outcome is debatable.ObjectiveTo assess the possible factors that might have influenced the postoperative outcome of a group of drug-resistant mesial MTLE patients who underwent stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RFTC).DesignSingle-center, retrospective.MethodsThe present study utilized a pre- and postoperative gray matter voxel-by-voxel ablation mapping comparison approach, along with a white matter mapping of longitudinal changes in the native space technique, to evaluate the association between the post-SEEG implantation signal recordings (obtained from clinically relevant electrode contacts used during RFTC) and the post-RFTC ablation volume of the different selected regions of interest (ROIs).ResultsThe study included 22 patients (12 men and 10 women, mean age 28.86 ± 14.04 years). Sixteen patients (72.72%) were seizure-free (SF), and six patients (27.27%) were non-SF. Five patients (22.72%) experienced mild side effects following RFTC. The post-RFTC follow-up period varied from 12 to 48 months, with an average of 24.17 ± 9.86 months. The SF group was associated with a higher number of implanted electrode contacts in the amygdala that were used during RFTC, a larger preoperative volume of the amygdala; a larger ablation volume of both the amygdala and rhinal cortex. The ablation volume of the white matter was statistically similar between both groups.ConclusionThis study provides valuable insights into the significance of the amygdala and rhinal cortex as ROIs in the preoperative evaluation of patients with MTLE. Future implantation scheme plans should consider evaluating the preoperative volume of these ROIs. Additionally, increasing the number of electrode contacts implanted within these regions might be beneficial to capture more clinically relevant signals and enhance their ablation volume.

Project description:IntroductionIn this report, we aim to describe the design for the randomised controlled trial of Stereotactic electroencephalogram (EEG)-guided Radiofrequency Thermocoagulation versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis (STARTS). Mesial temporal lobe epilepsy (mTLE) is a classical subtype of temporal lobe epilepsy that often requires surgical intervention. Although anterior temporal lobectomy (ATL) remains the most popular treatment for mTLE, accumulating evidence has indicated that ATL can cause tetartanopia and memory impairments. Stereotactic EEG (SEEG)-guided radiofrequency thermocoagulation (RF-TC) is a non-invasive alternative associated with lower seizure freedom but greater preservation of neurological function. In the present study, we aim to compare the safety and efficacy of SEEG-guided RF-TC and classical ATL in the treatment of mTLE.Methods and analysisSTARTS is a single-centre, two-arm, randomised controlled, parallel-group clinical trial. The study includes patients with typical mTLE over the age of 14 who have drug-resistant seizures for at least 2 years and have been determined via detailed evaluation to be surgical candidates prior to randomisation. The primary outcome measure is the cognitive function at the 1-year follow-up after treatment. Seizure outcomes, visual field abnormalities after surgery, quality of life, ancillary outcomes, and adverse events will also be evaluated at 1-year follow-up as secondary outcomes.DiscussionSEEG-guided RF-TC for mTLE remains a controversial seizure outcome but has the advantage for cognitive and visual field protection. This is the first RCT studying cognitive outcomes and treatment results between SEEG-guided RF-TC and standard ATL for mTLE with hippocampal sclerosis. This study may provide higher levels of clinical evidence for the treatment of mTLE.Trial registrationClinicalTrials.gov NCT03941613 . Registered on May 8, 2019. The STARTS protocol has been registered on the US National Institutes of Health. The status of the STARTS was recruiting and the estimated study completion date was December 31, 2021.

Project description:Percutaneous radiofrequency thermocoagulation (RFT) of the Gasserian ganglion is an effective treatment for primary trigeminal neuralgia (pTN). Currently Hartel anterior approach is the most commonly used method to access the Gasserian ganglion. However, this approach is associated with high recurrence rate and technical difficulties in certain patients with foramen ovale (FO) anatomical variations. In the present study, we assessed the feasibility of accessing the Gasserian ganglion through the FO from a mandibular angle under computed tomography (CT) and neuronavigation guidance.A total of 108 patients with TN were randomly divided into 2 groups (Group G and Group H) using a random number table. In Group H, Hartel anterior approach was used to puncture the FO; whereas in Group G, a percutaneous puncture through a mandibular angle was used to reach the FO. In both groups, procedures were guided by CT imaging and neuronavigation. The success rates, therapeutic effects, complications, and recurrence rates of the 2 groups were compared.The puncture success rates in Group H and Group G were 52/54 (96.30%) and 49/54 (90.74%), respectively (P = 0.24). The 2 procedural failures in Group H were rescued by using submandibular trajectory, and the 5 failures in Group G were successfully reapproached by Hartel method. Therapeutic effects as measured by Barrow Neurological Institute (BNI) pain scale (P = 0.03) and quality of life (QOL) scores (P = 0.04) were significantly better in Group G than those in Group H at 36 months posttreatment. Hematoma developed in 1/54 (1.85%) cases in Group H, and no cases of hematoma were observed in Group G (P = 0.33). In Group H, RFT resulted in injury to the unintended trigeminal nerve branches and motor fibers in 27/52 (51.92%) cases; in Group G, it resulted in the same type of injury in 7/49 cases (14.29%) (P < 0.01). In Group H, the 24- and 36-month recurrence rates were 12/51 (23.53%) and 20/51 (39.22%), respectively; in Group G, these recurrence rates were 7/49 (12.24%) and 9/49 (16.33%, P = 0.03), respectively.CT- and neuronavigation-guided puncture from a mandibular angle through the FO into the Gasserian ganglion can be safely and effectively used to deliver RFT for the treatment of pTN. This method may represent a viable option to treat TN in addition to Hartel approach.

Dataset Information

Optimization and high-density array of stereoelectroencephalography-guided radiofrequency thermocoagulation for the treatment of pediatric tuberous sclerosis complex with epilepsy.

Background

Methods

Results

Conclusion

Publications

Optimization and high-density array of stereoelectroencephalography-guided radiofrequency thermocoagulation for the treatment of pediatric tuberous sclerosis complex with epilepsy.

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