title: Stereo electroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in drug-resistant focal epilepsy: Results from a 10-year experience.
abstract: Stereo electroencephalography (SEEG)-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) has been proposed since 2004 as a possible treatment of some focal drug-resistant epilepsy. The aim of this study is to provide extensive data about efficacy and safety of SEEG-guided RF-TC.
  
  
  
  Over a 10-year period, 162 patients with drug-resistant focal epilepsy were eligible for SEEG-guided RF-TG during phase II invasive investigation by SEEG. All follow-up and safety data were collected prospectively. The primary outcome was seizure freedom at 2 months and at 1 year after SEEG-guided RF-TC. Secondary outcomes were the responders' rate (patient with at least 50% decrease in seizure frequency) and their long-term follow-up.
  
  
  
  Twenty-five percent of patients were seizure-free at 2 months and 7% at 1 year. We reported 67% of responders at 2 months and 48% at 1 year; 58% of responders maintained their status during the long-term follow-up. The seizure outcome was significantly better when the SEEG-guided RF-TC involved the occipital region (p = 0.007). When surgery followed an SEEG-guided RF-TC, the positive predictive value of being a responder 2 months after an SEEG-guided RF-TC and to be Engel's class I or II after surgery was 93%. We reported 1.1% of permanent deficit and 2.4% of transient side effects.
  
  
  
  Our results, gathered in a large population over a 10-year period, confirm that SEEG-guided RF-TC is a safe technique, being efficient in many cases. More than two thirds of patients showed a short-term improvement, and almost half of them were responders at 1-year follow-up. The technique appears to be especially interesting for limited epileptic zone inaccessible to surgery and when epilepsy is related to a large unilateral network (network disruption by multiple RF-TC). Furthermore, SEEG-guided RF-TC effect is a predictor of outcome after conventional cortectomy in patients eligible for surgery.
authors.affiliation: Department of Neurosurgery, Hospices Civils de Lyon (Lyon University Hospital), Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.|Lyon University, Claude Bernard University, Lyon, France.|Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France.|Sorbonne University, Pierre and Marie Curie University, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourdillon
authors.affiliation: Department of Functional Neurology and Epileptology, Hospices Civils de Lyon (Lyon University Hospital), Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.|Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292, Lyon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Isnard
authors.affiliation: Department of Functional Neurology and Epileptology, Hospices Civils de Lyon (Lyon University Hospital), Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Catenoix
authors.affiliation: Department of Functional Neurology and Epileptology, Hospices Civils de Lyon (Lyon University Hospital), Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.|Department of Pediatric Clinical Neurophysiology, Hospices Civils de Lyon (Lyon University Hospital), Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Montavont
authors.affiliation: Lyon University, Claude Bernard University, Lyon, France.|Department of Functional Neurology and Epileptology, Hospices Civils de Lyon (Lyon University Hospital), Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.|Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292, Lyon, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Rheims
authors.affiliation: Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292, Lyon, France.|Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ryvlin
authors.affiliation: Department of Pediatric Clinical Neurophysiology, Hospices Civils de Lyon (Lyon University Hospital), Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Ostrowsky-Coste
authors.affiliation: Lyon University, Claude Bernard University, Lyon, France.|Department of Functional Neurology and Epileptology, Hospices Civils de Lyon (Lyon University Hospital), Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.|Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Mauguiere
authors.affiliation: Department of Neurosurgery, Hospices Civils de Lyon (Lyon University Hospital), Hospital for Neurology and Neurosurgery Pierre Wertheimer, Lyon, France.|Lyon University, Claude Bernard University, Lyon, France.|Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292, Lyon, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Guénot
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging / Q000628:therapy*; D004564:Electrocoagulation / Q000379:methods*; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015225:Magnetoencephalography; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D013238:Stereotaxic Techniques; D016896:Treatment Outcome; D055815:Young Adult
keywords: 
  SEEG
  ; Drug-resistant focal epilepsy; Epilepsy surgery; Radiofrequency; Stereotactic surgery