Stereo-EEG-guided radiofrequency thermocoagulation in patients with drug-resistant epilepsy: a systematic review

Background. Radiofrequency thermocoagulation (RFTC) allows for destruction of epileptogenic zone during stereo-electroencephalographic (stereo-EEG) monitoring. This technique can serve therapeutic and diagnostic purposes in the treatment of patients with drug-resistant epilepsy (DRE). Objective. A systematic review of literature data on RFTC, its technique, efficacy, and safety in patients with DRE. Material and methods. This review was conducted according to the PRISMA 2020 criteria and registered in the PROSPERO registry. Two researchers selected studies in three stages using appropriate keywords. Studies with sample size ≥ 5 patients devoted to RFTC in patients with DRE were included. Studies demonstrating the effectiveness of RFTC for seizures with a minimum follow-up of 6 months were eligible. Case reports, reviews, manuscripts without available full text and non-eligible studies were excluded. Results. The review included 41 articles and 1.417 patients. The main causes of RFTC during stereo-EEG were contraindications for resection, the need for additional information on location of ictal zone, coagulation as an additional method for epileptogenic zone destruction and treatment of seizures in patients with indications for resection. The overall complication rate ranged from 0% to 60% (in 5.3% of patients). Neurological deficit was transient in 64% of cases. Favorable outcomes (Engel I) after RFTC without additional treatment were achieved in 24.9% of patients with DRE. Conclusion. Stereo-EEG navigated RFTC is a promising technique for examination and treatment of patients with DRE. It is safe and effective. However, standardization of coagulation parameters and prospective multiple-center studies are needed to obtain more accurate data.