sEEG-guided radiofrequency ablation safely produced consistent 7-8 mm lesions in humans, with one patient reporting full recovery and seizure freedom at 7 months post-procedure.
sEEG-guided RFA with real-time temperature monitoring produces consistent lesions and may offer a safe, minimally invasive treatment for drug-resistant epilepsy.
INTRODUCTION: sEEG-guided radiofrequency ablation (RFA) is an emerging therapeutic option for drug-resistant epilepsy patients. The procedure leverages the implanted sEEG electrodes for seizure localization to deliver targeted thermal ablations. In 2023, the FDA cleared the first sEEG-guided RFA system with real-time temperature monitoring and control. METHODS: Lesions were assessed in size in ex vivo chicken breast and in vivo swine brain (70–90°C; 30–600s). Clinical experience was summarized from published literature (AES2024 abstract1.552), surgeon feedback, and a patient interview. RESULTS: The system was designed to incorporate placement of a thermocouple behind the ablation contact(s) to continuously monitor temperature and impedance. The generator dynamically adjusts power to maintain target temperature. Users can modify ablation parameters (temperature, duration) in real-time. Lesion size in chicken breast and swine brain were proportional to temperature and duration and were similar in size. For 80-85°C and 2-5 min duration lesions diameter was 6-8mm. Initial clinical experience was presented at the American Epilepsy Society 2024 meeting. in one center (Cleveland Clinic), three patients underwent sEEG-guided RFA (80–85°C, 2–5 min, bipolar configuration). The procedure was well tolerated and lesions averaging 7–8 mm in diameter were visible in the MRI. Another patient who underwent RFA at the Mayo Clinic Jacksonville was interviewed ∼7 months post-RFA and reported full recovery and seizure freedom. Surgeons found the system safe, reliable, and easy to use, both in preclinical and clinical settings. Real-time thermal feedback allowed for controlled and consistent lesioning. CONCLUSIONS: The temperature-controlled sEEG-guided RFA system produced consistent lesions across ex vivo, in vivo, and human applications. This system offers a promising tool for focal epilepsy diagnosis and treatment, with the potential to keep patients on the path to seizure freedom with a minimally-invasive step, bedside, without care interruption.
Kullmann et al. (Thu,) conducted a other in Drug-resistant epilepsy (n=4). sEEG-guided radiofrequency ablation (RFA) with real-time temperature monitoring was evaluated on Lesion size, safety, and seizure freedom. sEEG-guided radiofrequency ablation safely produced consistent 7-8 mm lesions in humans, with one patient reporting full recovery and seizure freedom at 7 months post-procedure.