Authors :
Presenting Author: Jenny Lin, MD – Children’s Healthcare of Atlanta
Guojun Zhang, MD – Children’s Healthcare of Atlanta
Sonam Bhalla, MD – Emory University/ Children's Healthcare of Atlanta
Ammar Kheder, MD, MRCP – Michigan State University
Joshua Chern, MD – Childrens Healthcare of Atlanta
Rationale:
Radiofrequency thermocoagulation (RFTC) has become a more widely used therapy in epilepsy surgery. Unlike other surgical treatments like laser interstitial thermal therapy (LITT) or resection, RFTC has the benefit of targeting a focused area in a minimally invasive way at bedside via stereotactic depth electrodes without sedation. Thus, RFTC lends itself well to pediatric patients. However, responder rates are variable from 26-90%,1,2 and the role of RFTC in pediatric epilepsy is still evolving. In this case series, the authors report the experience and outcomes of RFTC in pediatric refractory epilepsy patients.
Methods:
Retrospective hart review was done for pediatric patients who underwent RFTC from June 2022-May 2024 at Children’s Healthcare of Atlanta.
Results:
Thirteen patients (mean age 15.2+3.9 years, 8 males) underwent RFTC. Clinical characteristics are in Table 1. SEEG was performed in all patients. Seizure onset zone (SOZ) was frontal in 3/13 (23%), temporal in 2/13 (15%), occipitotemporal in 2/13 (15%), primary sensorimotor cortex in 2/13 (15%), temporoparietal in 1/13 (8%), and two seizure foci or bilateral onset in 3/13 (23%).
unctional cortical mapping revealed potential deficits in the SOZ in 11/13 patients (85%): 6 (55%) language disruption, 2 (18%) hand motor function, 2 (18%) hand sensation, 1 (9%) visual function, and 1 (9%) prosopagnosia. After RFTC, 8 (62%) had a second destructive intervention (7 resection, 1 LITT), 1 (8%) had responsive neurostimulation, 1 (8%) had vagal nerve stimulation, and 3/13 had no other intervention.
Follow-up time from RFTC was 22+8.3 months (n=13) and from secondary intervention was 17+5.7 months (n=8). Outcomes were as follows: 6/13 (46%) with Engel I, 2/13 (15%) with Engel II, 3/13 (23%) with Engel III, and 2/13 (15%) with Engel IV. Of those with Engel I, 5/6 (83%) had a second destructive intervention. Within Engel II, 1/2 (50%) was seizure free 5 months prior to seizure recurrence. Of those with Engel III/IV, 5/5 had multifocal foci or rapid bilateral spread.