SEEG-guided radiofrequency thermocoagulation of epileptic foci in the paediatric population: Feasibility, safety and efficacy.
PURPOSE
Focal epilepsy in children may be refractory to pharmacological treatment and surgical resection may be an appropriate option. When invasive electroencephalogram is required in the presurgical evaluation, depth electrodes can be used to create focal lesions in the epileptogenic zone using radiofrequency thermocoagulation (RFTC), to disrupt the epileptogenic zone.


METHODS
This study aimed to assess the efficacy and safety of RFTC in a paediatric population of 46 patients.


RESULTS
The mean age of onset was 3.3 years and the mean age at SEEG was 8.2 years. MRI lesions were identified in 71.7% of the series, among them 60% of malformation of cortical development. 43.5% of the patients were seizure free at 1 month, 26.1% were responders. The mean duration of improvement was 6.8 months. 8 children were seizure free for >8 months and among them, 6 are currently seizure free for 8-24 months. 5 patients had functional deficits post-procedures, transient in 4 patients and prolonged in one of whom. 3/5 were anticipated following the results of cortical stimulation. Multivariate analysis found 3 independent criteria linked to RFTC efficiency one month after RFTC: frequency of the seizures before RFTC, age and number of contacts used.


CONCLUSION
RFTC is a safe method for the paediatric population providing important predictive information for surgical resection. An improvement in seizure frequency, often transient, is seen in 2/3 of our patients. RTFC could be useful as a palliative technique for children with an epileptogenic zone overlapping with eloquent areas, with minimal risk of sequelae.
['Chipaux|Mathilde|M|', 'Taussig|Delphine|D|', 'Dorfmuller|Georg|G|', 'Dorison|Nathalie|N|', 'Tisdall|Martin M|MM|', 'Boyd|Stewart G|SG|', 'Thornton|Rachel|R|', 'Eltze|Christin|C|', 'Fohlen|Martine|M|', 'Cross|Helen J|HJ|', 'Ferrand-Sorbets|Sarah|S|']
D000293:Adolescent D001921:Brain D002648:Child D002675:Child, Preschool D000069279:Drug Resistant Epilepsy D004564:Electrocoagulation D004828:Epilepsies, Partial D005240:Feasibility Studies D006801:Humans D007223:Infant D011446:Prospective Studies D011788:Quality of Life D000078702:Radiofrequency Therapy D012640:Seizures D016896:Treatment Outcome
Thermocoagulation Paediatrics Epilepsy Children Epilepsy surgery Invasive EEG stereoEEG