Stereotactic EEG-guided radiofrequency thermocoagulation versus anterior temporal lobectomy for mesial temporal lobe epilepsy with hippocampal sclerosis: study protocol for a randomised controlled trial.

INTRODUCTION: In this report, we aim to describe the design for the randomised controlled trial of Stereotactic electroencephalogram (EEG)-guided Radiofrequency Thermocoagulation versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis (STARTS). Mesial temporal lobe epilepsy (mTLE) is a classical subtype of temporal lobe epilepsy that often requires surgical intervention. Although anterior temporal lobectomy (ATL) remains the most popular treatment for mTLE, accumulating evidence has indicated that ATL can cause tetartanopia and memory impairments. Stereotactic EEG (SEEG)-guided radiofrequency thermocoagulation (RF-TC) is a non-invasive alternative associated with lower seizure freedom but greater preservation of neurological function. In the present study, we aim to compare the safety and efficacy of SEEG-guided RF-TC and classical ATL in the treatment of mTLE. METHODS AND ANALYSIS: STARTS is a single-centre, two-arm, randomised controlled, parallel-group clinical trial. The study includes patients with typical mTLE over the age of 14 who have drug-resistant seizures for at least 2 years and have been determined via detailed evaluation to be surgical candidates prior to randomisation. The primary outcome measure is the cognitive function at the 1-year follow-up after treatment. Seizure outcomes, visual field abnormalities after surgery, quality of life, ancillary outcomes, and adverse events will also be evaluated at 1-year follow-up as secondary outcomes. DISCUSSION: SEEG-guided RF-TC for mTLE remains a controversial seizure outcome but has the advantage for cognitive and visual field protection. This is the first RCT studying cognitive outcomes and treatment results between SEEG-guided RF-TC and standard ATL for mTLE with hippocampal sclerosis. This study may provide higher levels of clinical evidence for the treatment of mTLE. TRIAL REGISTRATION: ClinicalTrials.gov NCT03941613 . Registered on May 8, 2019. The STARTS protocol has been registered on the US National Institutes of Health. The status of the STARTS was recruiting and the estimated study completion date was December 31, 2021.

Stereo-crossed ablation guided by stereoelectroencephalography for epilepsy: comprehensive coagulations via a network of multi-electrodes.

BACKGROUND: Introducing multiple different stereoelectroencephalography electrodes in a three-dimensional (3D) network to create a 3D-lesioning field or stereo-crossed radiofrequency thermocoagulation (scRF-TC) might create larger lesioning size; however, this has not been quantified to date. This study aimed to quantify the configurations essential for scRF-TC. METHODS: By using polyacrylamide gel (PAG), we investigated the effect of electrode conformation (angled/parallel/multiple edges) and electrode distance of creating an electrode network. Volume, time, and temperature were analyzed quantitatively with magnetic resonance imaging, video analysis, and machine learning. A network of electrodes to the pathological left area 47 was created in a patient; the seizure outcome and coverage range were further observed. RESULTS: After the compatibility test between the PAG and brain tissue, the sufficient distance of contacts (from different electrodes) for confluent lesioning was 7 mm with the PAG. Connection to the lesioning field could be achieved even with a different arrangement of electrodes. One contact could achieve at least six connections with different peripheral contacts. Coagulation with a network of electrodes can create more significant lesioning sizes, 1.81-2.12 times those of the classic approaches. The confluent lesioning field created by scRF-TC had a volume of 38.7 cm3; the low metabolic area was adequately covered. The representative patient was free of seizures throughout the 12-month follow up. CONCLUSION: Lesioning with electrodes in a network manner is practical for adequate 3D coverage. A secondary craniotomy could be potentially prevented by combining both monitoring and a large volume of lesions.

Asymmetry of Cerebral Peduncles for Predicting Motor Function Restoration in Young Patients Before Hemispherectomy.

OBJECTIVE: Hemispherectomy has been used successfully for patients with medically intractable epilepsy. However, it is difficult to predict postoperative motor function. The aim of the present study was to analyze whether the preoperative asymmetry of cerebral peduncles could be used to predict motor function restoration before hemispherectomy for young patients with medically intractable epilepsy. METHODS: The clinical record and magnetic resonance imaging data of 53 patients were analyzed retrospectively. The correlation between preoperative cerebral peduncle asymmetry ratio (pCPAR) and pre- and postoperative changes in motor function was evaluated, as well as the influencing factors for pCPAR, such as duration and etiology factors. The restoration of motor function was defined as changes in pre- and postoperative hemiparesis. RESULTS: The pCPARs of patients with improved and unchanged hemiparesis were significantly greater than that of worsened patients. Patients with a pCPAR of more than 1.5 had an obvious restorative capacity of motor function of the intact hemisphere, and these patients had a lower risk of worsening hemiparesis. The duration in the improved/unchanged and worsened groups was 5.84 ± 3.85 years and 2.67 ± 2.03 years, respectively. Furthermore, there were more patients with no-progressive pathology in the group in whom pCPAR was more than 1.5. CONCLUSIONS: pCPAR is a useful and objective indicator for predicting the restoration of motor function in pediatric patients with medically intractable epilepsy before hemispherectomy. Most patients with nonprogressive pathology and a duration of more than 5 years presented with greater pCPARs, exhibited better restoration of motor function, and had less risk of worsening hemiparesis.