Resolution of bilateral temporal lobe epilepsy via minimally invasive stereoelectroencephalogram-guided asymmetric radiofrequency thermocoagulation: a case report

• Published in: Therapeutic advances in neurological disorders Vol. 18; p. 17562864251321255
• Main Authors: Liu, Zhao, Luan, Guoming, Wang, Mengyang, Wang, Jing, Teng, Pengfei, Guan, Yuguang, Wang, Xiongfei, Li, Tianfu, Cui, Tianyi, Zhou, Jian
• Format: Journal Article
• Language: English
• Published: England SAGE Publications 01.01.2025; SAGE Publishing
• Subjects: Case Report; neural compensation; stereoelectroencephalogram; radiofrequency thermocoagulation; neuropsychological function; bilateral temporal lobe epilepsy
• ISSN: 1756-2864; 1756-2856; 1756-2864
• DOI: 10.1177/17562864251321255

Bilateral temporal lobe epilepsy (TLE) is a complex form of epilepsy, characterized by seizures originating from both temporal lobes. Its intricate nature presents significant challenges for both medical and surgical treatment, often necessitating a multidisciplinary approach. While resective surgery is generally unsuitable for bilateral TLE, neuromodulation offers more of a remission-focused approach, which better preserves neuropsychological function. In this study, we presented the case of a 45-year-old female with a 16-years history of recurrent seizures, diagnosed as drug-resistant bilateral TLE. After a comprehensive multidisciplinary epilepsy evaluation—encompassing detailed patient history, neurological examination, scalp audiovisual electroencephalogram monitoring, high-resolution brain magnetic resonance imaging, neuropsychological testing, and cerebrospinal fluid analysis—stereoelectroencephalogram (SEEG) confirmed the diagnosis. The patient subsequently underwent asymmetric radiofrequency thermocoagulation guided by SEEG results, targeting bilateral temporal lobes. Despite experiencing transient psychiatric symptoms postprocedure, she achieved seizure freedom and showed improved neuropsychological function over a 3-year follow-up period. This case demonstrates that, with thorough evaluation, seizure freedom is attainable in bilateral TLE patients, even when bilateral injury is present, without significant impairment to neuropsychological function. Plain language summary Treatment of bilateral temporal lobe epilepsy using a less-invasive method: a case report on stereoelectroencephalography-guided radiofrequency ablation Bilateral temporal lobe epilepsy (BTLE) is a complicated type of epilepsy that causes seizures to start in both temporal lobes of the brain. Treating this condition can be challenging, so a team of specialists is often needed. Standard surgery to remove parts of the brain is usually not an option for BTLE, but neuromodulation offers a way to focus on reducing seizures while protecting brain function. In this study, we discuss the case of a 45-year-old woman who had been experiencing repeated seizures for 16 years, which were resistant to treatment. After a thorough evaluation by a team of specialists, including a detailed medical history, neurological exams, scalp audiovisual EEG monitoring, high-resolution brain MRI, neuropsychological tests, and cerebrospinal fluid analysis, the diagnosis was confirmed through stereoelectroencephalogram (SEEG). The patient then had asymmetric radiofrequency thermocoagulation, guided by SEEG findings, to treat both temporal lobes. Although she had temporary psychiatric symptoms after the procedure, she became seizure-free and showed improvements in her brain function during a follow-up period of three years. This case shows that with a careful evaluation, it is possible for patients with BTLE, even with damage in both lobes, to achieve freedom from seizures without significantly harming their brain function.