SEEG-guided radiofrequency thermocoagulation ablation for tuberous sclerosis-associated epilepsy_Journal of Epilepsy

Authors：

ZHANG Bingqing , WANG Haixiang , FENG Qian , HE Jing , LIN Jiuluan , BAI Jianjun ,  ZHOU Wenjing

Department of Neurosurgery Ward 3, Tsinghua University Yu-Quan Hospital, Beijing 100040, China;

Corresponding author：

ZHOU Wenjing, Email: closejeo@hotmail.com

Keywords：

Tuberous sclerosis complex; Epilepsy; Stereoelectroencephalography; Radiofrequency thermocoagulation

DOI：

10.7507/2096-0247.202403015

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To study the therapeutic efficacy of stereoelectroencephalography (SEEG)-guided radiofrequency thermo-coagulation ablation (RF-TC) in the treatment of tuberous sclerosis (TSC) related epilepsy and to investigate the prediction of the therapeutic response to SEEG-guided RF-TC for the efficacy of the subsequent surgical treatment. Methods We retrospectively analyze TSC patients who underwent SEEG phase II evaluation from January 2014 to January 2023, and to select patients who underwent RF-TC after completion of SEEG monitoring, study the seizure control of patients after RF-TC, and classify patients into effective and ineffective groups for RF-TC treatment according to the results of RF-TC treatment, compare the surgical outcomes of patients in the two groups after SEEG, to explore the prediction of surgical outcome by RF-TC treatment. Results 59 patients with TSC were enrolled, 53 patients (89.83%) were genetic detection, of which 28 (52.83%) were TSC1-positive, 21 (39.62%) were TSC2-positive, and 4 (7.54%) were negative, with 33 (67.34%) de novo mutations. The side of the SEEG electrode placement: left hemisphere in 9 cases, right hemisphere in 13 cases, and bilateral hemisphere in 37 cases. 37 patients (62.71%) were seizure-free at 3 months, 31 patients (52.54%) were seizure-free at 6 months, 29 patients (49.15%) were seizure-free at 12 months, and 20 patients (39.21%) were seizure-free at 24 months or more. 11 patients had a seizure reduction of more than 75% after RF-TC, and the remaining 11 patients showed no significant change after RF-TC. There were 48 patients (81.35%) in the effective group and 11 patients (18.65%) in the ineffective group. In the effective group, 22 patients were performed focal tuber resection laser ablation, 19 cases were seizure-free (86.36%). In the ineffective group, 10 patients were performed focal tuber resection laser ablation, only 5 cases were seizure-free (50%), which was a significant difference between the two groups (P<0.05). Conclusions Our data suggest that SEEG guided RF-TC is a safe and effective both diagnostic and therapeutic treatment for TSC-related epilepsy, and can assist in guiding the development of future resective surgical strategies and determining prognosis.

Citation： ZHANG Bingqing, WANG Haixiang, FENG Qian, HE Jing, LIN Jiuluan, BAI Jianjun, ZHOU Wenjing. SEEG-guided radiofrequency thermocoagulation ablation for tuberous sclerosis-associated epilepsy. Journal of Epilepsy, 2024, 10(3): 221-227. doi: 10.7507/2096-0247.202403015 Copy

1.	Ebrahimi-Fakhari D, Mann LL, Poryo M, et al. Incidence of tuberous sclerosis and age at first diagnosis: new data and emerging trends from a national, prospective surveillance study. Orphanet J Rare Dis, 2018, 13(1): 117.
2.	Cui J, Yu X, Liang S, et al. First five generations Chinese family of tuberous scleroses complex due to a new mutation of the TSC1 gene. J Clin Neurosci, 2018, 54: 39-44.
3.	Gül Mert G, Altunbaşak Ş, Hergüner Ö, et al. Factors affecting epilepsy prognosis in patients with tuberous sclerosis. Childs Nerv Syst, 2019, 35(3): 463-468.
4.	Northrup H, Krueger DA. International Tuberous Sclerosis Complex Consensus Group. Tuberous sclerosis complex diagnostic criteria update: recommendations of the 2012 Iinternational Tuberous Sclerosis Complex Consensus Conference. Pediatr Neurol, 2013, 49(4): 243-254.
5.	Chu-Shore CJ, Major P, Camposano S, et al. The natural history of epilepsy in tuberous sclerosis complex. Epilepsia, 2010, 51(7): 1236-1241.
6.	Curatolo P, Nabbout R, Lagae L, et al. Management of epilepsy associated with tuberous sclerosis complex: updated clinical recommendations. Eur J Paediatr Neurol, 2018, 22(5): 7 38-748.
7.	Krueger DA, Wilfong AA, Mays M, et al. Long-term treatment of epilepsy with everolimus in tuberous sclerosis. Neurology, 2016, 87(23): 2408-2415.
8.	Fohlen M, Taussig D, Ferrand-Sorbets S, et al. Refractory epilepsy in preschool children with tuberous sclerosis complex: early surgical treatment and outcome. Seizure, 2018, 60: 71-79.
9.	Liang S, Zhang J, Yang Z, et al. Long-term outcomes of epilepsy surgery in tuberous sclerosis complex. J Neurol, 2017, 264(6): 1146-1154.
10.	Ostrowsky-Coste K, Neal A, Guenot M, et al. Resective surgery in tuberous sclerosis complex, from penfield to 2018: a critical review. Rev Neurol (Paris), 2019, 175(3): 163-182.
11.	Arya R, Tenney JR, Horn PS, et al. Long-term outcomes of resective epilepsy surgery after invasive presurgical evaluation in children with tuberous sclerosis complex and bilateral multiple lesions. J Neurosurg Pediatr, 2015, 15(1): 26-33.
12.	Bourdillon P, Rheims S, Catenoix H, et al. Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC). Seizure, 2020, 77: 64-68.
13.	Northrup H, Aronow ME, Bebin EM, et al. International Tuberous Sclerosis Complex Consensus Group. Updated international tuberous sclerosis complex diagnostic criteria and surveillance and management recommendations. Pediatr Neurol, 2021, 123: 50-66.
14.	Isnard J, Taussig D, Bartolomei F, et al. French guidelines on stereoelectroencephalography (SEEG). Neurophysiol Clin, 2018, 48(1): 5-13.
15.	Martinez-Lizana E, Fauser S, Brandt A, et al. Long-term seizure outcome in pediatric patients with focal cortical dysplasia undergoing tailored and standard surgical resections. Seizure, 2018, 62: 66-73.

1. Ebrahimi-Fakhari D, Mann LL, Poryo M, et al. Incidence of tuberous sclerosis and age at first diagnosis: new data and emerging trends from a national, prospective surveillance study. Orphanet J Rare Dis, 2018, 13(1): 117.
2. Cui J, Yu X, Liang S, et al. First five generations Chinese family of tuberous scleroses complex due to a new mutation of the TSC1 gene. J Clin Neurosci, 2018, 54: 39-44.
3. Gül Mert G, Altunbaşak Ş, Hergüner Ö, et al. Factors affecting epilepsy prognosis in patients with tuberous sclerosis. Childs Nerv Syst, 2019, 35(3): 463-468.
4. Northrup H, Krueger DA. International Tuberous Sclerosis Complex Consensus Group. Tuberous sclerosis complex diagnostic criteria update: recommendations of the 2012 Iinternational Tuberous Sclerosis Complex Consensus Conference. Pediatr Neurol, 2013, 49(4): 243-254.
5. Chu-Shore CJ, Major P, Camposano S, et al. The natural history of epilepsy in tuberous sclerosis complex. Epilepsia, 2010, 51(7): 1236-1241.
6. Curatolo P, Nabbout R, Lagae L, et al. Management of epilepsy associated with tuberous sclerosis complex: updated clinical recommendations. Eur J Paediatr Neurol, 2018, 22(5): 7 38-748.
7. Krueger DA, Wilfong AA, Mays M, et al. Long-term treatment of epilepsy with everolimus in tuberous sclerosis. Neurology, 2016, 87(23): 2408-2415.
8. Fohlen M, Taussig D, Ferrand-Sorbets S, et al. Refractory epilepsy in preschool children with tuberous sclerosis complex: early surgical treatment and outcome. Seizure, 2018, 60: 71-79.
9. Liang S, Zhang J, Yang Z, et al. Long-term outcomes of epilepsy surgery in tuberous sclerosis complex. J Neurol, 2017, 264(6): 1146-1154.
10. Ostrowsky-Coste K, Neal A, Guenot M, et al. Resective surgery in tuberous sclerosis complex, from penfield to 2018: a critical review. Rev Neurol (Paris), 2019, 175(3): 163-182.
11. Arya R, Tenney JR, Horn PS, et al. Long-term outcomes of resective epilepsy surgery after invasive presurgical evaluation in children with tuberous sclerosis complex and bilateral multiple lesions. J Neurosurg Pediatr, 2015, 15(1): 26-33.
12. Bourdillon P, Rheims S, Catenoix H, et al. Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC). Seizure, 2020, 77: 64-68.
13. Northrup H, Aronow ME, Bebin EM, et al. International Tuberous Sclerosis Complex Consensus Group. Updated international tuberous sclerosis complex diagnostic criteria and surveillance and management recommendations. Pediatr Neurol, 2021, 123: 50-66.
14. Isnard J, Taussig D, Bartolomei F, et al. French guidelines on stereoelectroencephalography (SEEG). Neurophysiol Clin, 2018, 48(1): 5-13.
15. Martinez-Lizana E, Fauser S, Brandt A, et al. Long-term seizure outcome in pediatric patients with focal cortical dysplasia undergoing tailored and standard surgical resections. Seizure, 2018, 62: 66-73.

Journal of Epilepsy

SEEG-guided radiofrequency thermocoagulation ablation for tuberous sclerosis-associated epilepsy

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