TY - JOUR
T1 - Systematic review and patient-level meta-analysis of radiofrequency ablation for medically refractory epilepsy
T2 - Implications for clinical practice and research
AU - Kerezoudis, Panagiotis
AU - Tsayem, Idriss N.
AU - Lundstrom, Brian N.
AU - Van Gompel, Jamie J.
N1 - Publisher Copyright:
© 2022
PY - 2022/11
Y1 - 2022/11
N2 - 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.
AB - 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.
KW - Epilepsy surgery
KW - Meta-analysis
KW - Radiofrequency ablation
KW - Seizure freedom
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U2 - 10.1016/j.seizure.2022.10.003
DO - 10.1016/j.seizure.2022.10.003
M3 - Review article
C2 - 36219914
AN - SCOPUS:85139454603
SN - 1059-1311
VL - 102
SP - 113
EP - 119
JO - Seizure
JF - Seizure
ER -