Dados do Trabalho

Título

SEEG Guided Radiofrequency Thermocoagulation: Early Brazilian Experience From a Single Epilepsy Center

Introdução

The first report about Stereoelectroencephalography-guided radiofrequency-thermocoagulation (Thermo-SEEG) came from studies realized in 1965 to alleviate unmanageable behavior by selective amygdalectomy. Meanwhile, it was observed to have an unexpected positive effect on seizures. SEEG methodology allows a very accurate exploration of the epileptic network, but also provides the chance to generate thermocoagulation lesions of the epileptogenic zone using a radiofrequency (RF) generator. This technique offers several advantages, such as, It can be targeted on the epileptogenic zone (EZ) delineated by SEEG study. Those implanted electrodes carrying out the SEEG, thereby, do not significantly increase the surgical risk related to electrodes implantation by itself. Multiple lesions can be performed using adjacent register contacts. Thermo-SEEG should be preceded by a functional mapping through cortical stimulation, thus preventing the occurrence of a postlesion neurologic deficit. In addition, the procedure does not require anesthesia.

Objetivo

To evaluate the results of early Brazilian tertiary epilepsy center experience with Thermo-SEEG.

Método

We conducted a transversal study analyzing clinical records from patients who underwent Thermo-SEEG Procedures from 2019 to 2022. Thermo SEEG indication included patients whose resective surgery was too risky with regard to functional areas, or as an epileptogenic zone hypothesis proof of principle. RF thermocoagulation was performed between two contiguous contacts of the same electrode, including all contacts related to the EZ. 90 days postoperative ILAE outcome scale was used as an outcome measure.

Resultados

We analyzed 18 procedures in 17 patients. Thermo SEEG was the only treatment performed in 05 patientes (TT Group) and Thermo-SEEG followed by cortical resection made in 12 (PP Group). 30% of TT patients achieved ILAE Class 1 or 2. The correlation between reduced interictal epileptogenic activity after Thermo-SEEG and seizure outcome after surgical resection was 75%. Asymptomatic localized hematoma was the only complication detected and occurred in 5% of the procedures.

Conclusão

Early adoption of Thermo-SEEG in Brazil has similar results to the current literature. More centers should be encouraged to perform Thermo-SEEG as a palliative treatment, increasing the therapeutic armamentarium with a favorable risk-benefit ratio.

Palavras-chave

Thermo-SEEG; Epileptogenic zone; Cortical stimulation; Palliative treatment