Objective: To investigate the clinical value of stereo-electroencephalography guided radiofrequency thermos-coagulation (RFTC) in drug resistant temporal epilepsy. Methods: The clinical data of 12 patients with refractory temporal epilepsy who underwent implantation of SEEG electrodes and radiofrequency thermos-coagulation from July 2016 to November 2017 were analysed retrospectively. Results: The mean follow-up time was 6.4±4.6 months after thermos-coagulation, and 10.2±3.5 months after resection. Engel Ⅰa was observed in 9 cases, with Ⅱa, Ⅲa and Ⅳa 1 cases respectively. Nine patients experienced a ≥50% decrease of seizure frequency after RFTC (R+ , 75%), of whom one had got a sustained seizure free for 15 months and the other with decrease of seizure frequency by over 90% for 14 months. There was a statistical significance in seizure frequency between pre- and post-thermo-coagulation (P=0.008). Ten cases underwent open surgery following SEEG-guided RFTC, of them 8 cases got seizure free. RFTC was effective in 6 of 8 cases. In our group, all patients have not suffered from any neurologic and cognitive deficiency, and even several patients have some improvements on memory quotient. Conclusions: Although it is less effective than resective surgery, SEEG-guided RFTC can be a relatively safe, effective treatment because of its precision and minimal invasion for patients with complex drug resistant temporal epilepsy, especially for impossible any cortical resection. In addition, its effect may be a predictor of outcome after conventional cortectomy.
目的： 探讨立体定向脑电图(SEEG)引导射频热凝(RFTC)治疗难治性颞叶癫痫的临床应用价值。 方法： 对清华大学玉泉医院癫痫中心2016年1月至2017年11月的12例难治性颞叶癫痫患者全部行SEEG电极植入并热凝治疗。回顾性分析临床资料。 结果： 射频热凝后至切除术前随访(6.4±4.6)个月，切除术后随访(10.2±3.5)个月。Engel分级：Ⅰa级9例；Ⅱa，Ⅲa，Ⅳa级各1例。热凝后发作减少50%以上者9例；热凝后未行切除术2例，随访15个月无发作1例，另1例随访14个月发作减少90%以上。热凝前后发作频率差异有统计学意义(P＝0.008)。热凝后期行切除手术10例，术后无发作8例，其中6例热凝有效。所有患者热凝后无神经认知功能障碍，部分患者热凝后记忆商有不同程度改善。 结论： 虽然SEEG引导射频热凝效果不如切除术，但因其精准微创性，对于难治性颞叶癫痫患者，特别是不适合切除术者，可能会成为一种相对安全有效的治疗方法。另外，它可以有效预测切除术效果及指导手术方案。.
Keywords: Drug resistant epilepsy; Radiofrequency thermo-coagulation; Stereo-electroencephalography; Temporal epilepsy.