• Alexis Moles, Marc Guénot, Sylvain Rheims, Julien Berthiller, Hélène Catenoix, Alexandra Montavont, Karine Ostrowsky-Coste, Sebastien Boulogne, Jean Isnard, and Pierre Bourdillon.
• Department of Neurosurgery, Hospices Civils de Lyon, Neurology and Neurosurgery Hospital Pierre Wertheimer, 59, Bd Pinel, 69677, Bron, France. pierre.bourdillon@neurochirurgie.fr.
• J. Neurol. 2018 Sep 1; 265 (9): 1998-2004.

BackgroundStereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) is a super-selective procedure. Hippocampus has a limited volume and is widely accessible to SEEG so that SEEG-guided RF-TC could be an alternative to the anterior temporal lobectomy (ATL) in case of temporal lobe epilepsy (TLE) syndrome.ObjectiveTo compare seizure-free rate at 1-year follow-up between patients undergoing SEEG-guided RF-TC and patients undergoing ATL in TLE over a 15-year period.MethodsAll patients had a drug-resistant epilepsy and underwent SEEG after non-conclusive phase I investigations suspecting a TLE. Two groups were selected according to the procedure which the patients underwent (ATL or SEEG-guided RF-TC); TLE had to be confirmed by SEEG in the two groups. The primary outcome was seizure freedom at 1 year. The secondary outcome was response (at least 50% reduction of seizure frequency) at 1 year. In case of persistent seizures after SEEG-guided RF-TC, ATL was performed.ResultsA total of 21 patients underwent SEEG-guided RF-TC and 49 ATL. At 12 months, none of the patients of the SEEG-guide RF-TC group was seizure free, while 37 (75.5%) in the ATL group were so (p < 0.001). Ten patients (47.6%) were responders after 12 months of follow-up after SEEG-guided RF-TC; all patients in the ATL group who were seizure free were responders.ConclusionSEEG-guided RF-TC is not as effective as ATL in TLE. As no memory impairment following SEEG-guided RF-TC was found, patients with dominant mesial involvement for whom hippocampectomy is not an option could benefit from the technique.

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