Disrupting the epileptogenic network with stereoelectroencephalography‐guided radiofrequency thermocoagulation

Abstract Stereoelectroencephalography‐guided radiofrequency thermocoagulation (SEEG‐guided RF‐TC) is a treatment option for focal drug‐resistant epilepsy. In previous studies, this technique has shown seizure reduction by ≥50% in 50% of patients at 1 year. However, the relationship between the location of the ablation within the epileptogenic network and clinical outcomes remains poorly understood. Seizure outcomes were analyzed for patients who underwent SEEG‐guided RF‐TC and across subgroups depending on the location of the ablation within the epileptogenic network, defined as SEEG sites involved in seizure generation and spread. Eighteen patients who had SEEG‐guided RF‐TC were included. SEEG‐guided seizure‐onset zone ablation (SEEG‐guided SOZA) was performed in 12 patients, and SEEG‐guided partial seizure‐onset zone ablation (SEEG‐guided P‐SOZA) in 6 patients. The early spread was ablated in three SEEG‐guided SOZA patients. Five patients had ablation of a lesion. The seizure freedom rate in the cohort ranged between 22% and 50%, and the responder rate between 67% and 85%. SEEG‐guided SOZA demonstrated superior results for both outcomes compared to SEEG‐guided P‐SOZA at 6 months (seizure freedom p = .294, responder rate p = .014). Adding the early spread ablation to SEEG‐guided SOZA did not increase seizure freedom rates but exhibited comparable effectiveness regarding responder rates, indicating a potential network disruption.