Subsequent epilepsy surgery after SEEG-guided radiofrequency thermocoagulation: Outcomes and prognostic value of treatment response-a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis assessed outcomes after resective, disconnective, or ablative epilepsy surgery in patients previously treated with SEEG-guided radiofrequency thermocoagulation (SEEG-RFTC), and whether response to RFTC predicted later surgical outcome. Across six studies with 194 patients, 141 had a favorable seizure outcome; the pooled proportion was 72.4% (95% CI, 65.6%-78.3%; I 2 = 0%). Three studies compared RFTC responders and nonresponders. Responders had numerically higher odds of favorable outcome, but estimates were imprecise and did not establish prognostic value.

Key findings

• After subsequent epilepsy surgery, the pooled favorable seizure-outcome proportion was 72.4% (95% CI, 65.6%-78.3%; I 2 = 0%).
• RFTC responders had higher estimated odds of favorable later outcome (odds ratio, 3.86; 95% CI, 0.80-18.57), but Hartung-Knapp inference widened the interval to 0.19-77.91 (P = .193).
• The pooled proportion proceeding to another epilepsy procedure was 22.0% (95% CI, 11.1%-38.8%; I 2 = 84.1%).
• Permanent neurological complications occurred in 2.7% (95% CI, 1.0%-6.9%).

Why it matters

The findings suggest that favorable seizure outcomes are achievable in selected patients who proceed to definitive epilepsy surgery after SEEG-RFTC. RFTC response may contribute information about the proposed epileptogenic network, but the available comparisons are too uncertain to establish it as an independent prognostic marker. This distinction matters when interpreting RFTC response during surgical evaluation.

What to keep in mind

The prognostic comparison was based on only three studies and had wide uncertainty, particularly under small-sample sensitivity analysis. The pooled outcomes also reflect selected patients who proceeded to subsequent surgery.