Stereoelectroencephalography‐guided radiofrequency thermocoagulation in drug‐resistant focal epilepsy: Results from more than 20 years of experience

Abstract Objective This study was undertaken to present more than 2 decades of experience with stereoelectroencephalography (SEEG)‐guided radiofrequency thermocoagulation (RF‐TC) in focal drug‐resistant epilepsy and to identify clinical, electrophysiological, and procedural predictors of treatment response. Methods We retrospectively studied 244 consecutive patients treated with SEEG‐guided RF‐TC at our center between 2001 and 2024. All had at least 2 months of follow‐up, and 240 (98.4%) completed 1 year. Outcomes were assessed at 2, 6, and 12 months. The primary endpoint was seizure freedom at 2 months and 1 year without additional surgery, and the secondary endpoint was ≥50% seizure reduction. Demographic and epilepsy‐, imaging‐, and procedure‐related variables were analyzed. Results At 2 months, 160 patients (65.6%) were responders, including 63 (25.8%) seizure‐free. At 1 year, among 135 patients treated exclusively with SEEG‐guided RF‐TC, 64 (51.2%) were responders, including 19 (14.1%) seizure‐free. At 5 years, 6.1% treated exclusively with SEEG‐guided RF‐TC remained seizure‐free. Magnetic resonance imaging was negative in 40.6%, and focal cortical dysplasia was the most frequent imaging finding (20.1%). A higher number of contacts was associated with lower seizure‐free rates at 1 year ( p  = .046). Pathology and electrode number were the only variables associated with 1‐year outcomes. The positive predictive value of being a responder at 2 months for favorable surgical outcome was 83%, and the negative predictive value was 44%. Recoagulation within the first year was strongly associated with clinical improvement ( p   Significance SEEG‐guided RF‐TC is a safe diagnostic option with some therapeutic implication (6% seizure freedom in 5 years) for selected patients with drug‐resistant focal epilepsy. Early response predicts favorable long‐term outcomes, and repeated coagulation can enhance clinical results. Pathology and the number of contacts used in thermocoagulation may serve as potential prognostic factors.