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MRI-negative medial temporal lobe epilepsy can benefit from stereotactic radiofrequency thermocoagulation applied to the amygdalohippocampal complex

Author(s):

Wenqian Zhang, Jia Wang, Quanjun Zhao*, Tao Wang and Peixin Wang  

Abstract:


Background: Seizure control [SC] is often poor in cases of magnetic resonance imaging-negative epilepsy after resection surgery.

Objective: This study aimed to evaluate the therapeutic efficacy of depth-electrode-guided stereotactic radiofrequency thermocoagulation [RFTC] applied to the amygdalohippocampal complex [AHC] for the treatment of patients with MRI-negative medial temporal lobe epilepsy.

Methods: A total of 62 cases with magnetic resonance imaging-negative medial temporal lobe epilepsy were retrospectively studied after the application of depth-electrode-guided RFTC to the AHC. Single-target coagulations were applied to all patients, and multi-target coagulations were applied to those patients who did not experience significant reductions in discharges after the first target ablation. Bilateral-target coagulations were applied to bilateral medial temporal lobe epilepsy patients, using single target ablation applied to each side.

Results: After 24–83 months of follow-up, 32/62 [51.61%] patients became seizure-free, and 35/62 [56.45%] patients reported significant reductions in seizure episodes. The total effective rate was 69.35% [43/62]. No significant differences were observed for SC among the single-target, multi-target and bilateral-target groups. However, a significant difference was observed for the reduction in epileptic discharges after coagulations between those patients who became seizure-free and those who did not. Magnetic resonance imaging-negative medial temporal lobe epilepsy patients can benefit from RFTC applied to the AHC. A significant reduction in epileptic discharges observed during operations after RFTC is applied may be a predictor of good SC.

Conclusion: RFTC applied to the AHC could be considered a promising method for the treatment of magnetic resonance imaging-negative medial temporal lobe epilepsy patients.

Keywords:

Seizure control, Amygdalohippocampal complex, Medial temporal lobe epilepsy, MRI-negative epilepsy, Radiofrequency thermocoagulation, predictor

Affiliation:

306th Clinical College of PLA, The Fifth Clinlcal Medical College, Anhui Medical University, 306th Clinical College of PLA, The Fifth Clinlcal Medical College, Anhui Medical University, Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center, Department of Neurosurgery, PLA Strategic Support Force Characteristic Medical Center



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