SEEG-guided Radiofrequency Ablation for Drug-Resistant Focal Epilepsy: Prognostic and Therapeutic Implications

Summary

Background Drug-resistant focal epilepsy presents significant therapeutic challenges, often necessitating surgical interventions. Stereoelectroencephalography (SEEG)-guided radiofrequency ablation (RFA) has emerged as a minimally invasive technique targeting the epileptogenic zone. This study evaluates the effectiveness of SEEG-guided RFA in achieving seizure control and its predictive value for outcomes of subsequent surgical interventions. Methods The study retrospectively analyzed 62 patients who underwent SEEG-guided RFA for drug-resistant focal epilepsy. After excluding five patients, 57 were assessed based on their procedural outcomes. The primary outcomes measured were seizure freedom post-RFA and the correlation between transient seizure freedom after RFA and the success of subsequent surgical procedures, including laser interstitial thermal therapy (LITT), resection, or neuromodulation. Findings and Implications Approximately 25% of patients achieved seizure freedom following RFA. Of the 70% who underwent subsequent surgical interventions, a longer duration of seizure freedom after RFA was predictive of favorable outcomes in these secondary surgeries, with 74% of these procedures being LITT. These findings suggest that SEEG-guided RFA not only serves as a therapeutic modality but also as a prognostic tool for guiding future surgical strategies in patients with drug-resistant focal epilepsy.