Stereoelectroencephalography‐guided radiofrequency thermocoagulation for drug‐resistant epilepsy: A meta‐analysis

Abstract Objective In patients with focal drug‐resistant epilepsy (DRE), resective epilepsy surgery correlates with high rates of remission. However, in cases where the epileptic region is deemed surgically inaccessible, or when it involves a complex network, stereoelectroencephalography‐guided radiofrequency thermocoagulation (SEEG‐RFTC) might be an alternative therapeutic strategy. However, most of the available evidence is limited to small observational studies. An updated meta‐analysis is warranted to provide a comprehensive assessment of SEEG‐RFTC in patients with DRE. Methods Databases were searched until September 9, 2023 to identify published studies reporting on the effectiveness of SEEG‐RFTC in patients with DRE. The primary outcomes of interest were the 1‐year seizure‐freedom rate and response rate (50% seizure frequency decrease from baseline). These outcomes were pooled using the inverse variance and a random‐effects model. Results We screened 182 articles and included 16 retrospective cohort studies. A total of 437 unique patients from 12 nonoverlapping cohorts were analyzed for seizure and complication outcomes. The pooled seizure‐free rate after 1 year was 37.8% (95% confidence interval [CI] = 24.7%–50.8%), whereas the seizure response rate after 1 year was 69.7% (95% CI = 52.7%–86.7%). There was high heterogeneity among the included studies. Subgroup analysis revealed that patients with nodular heterotopia achieved higher rates of seizure freedom (57.1%, 95% CI = 38.8%–75.5%) compared to those with cortical dysplasia (CD) and magnetic resonance imaging‐negative conditions. Furthermore, hippocampal sclerosis patients exhibited higher seizure freedom rates (66.7%, 95% CI = 49.8%–83.5%) than those with CD (12.0%, 95% CI = .0%–24.7%). Significance SEEG‐RFTC might be an effective therapeutic option for seizure control in patients with DRE who undergo SEEG for DRE workup. The role of SEEG‐RFTC as a potential adjunct therapy to laser interstitial thermal therapy or surgical resection should be explored. This study highlights the need for well‐designed clinical trials to compare SEEG‐guided RFTC with other therapeutic modalities.