Radiofrequency ablation of the centromedian thalamic nucleus in the treatment of drug-resistant epilepsy

• Published in: Epilepsy & behavior 2021-01, Vol.114 (Pt A), p.107560-107560, Article 107560
• Main Authors: Aguado-Carrillo, Gustavo, Velasco, Ana Luisa, Saucedo-Alvarado, Pablo Eduardo, Cuellar-Herrera, Manola, Trejo-Martínez, David, Navarro-Olvera, Jose Luis, Heres-Becerril, Stephani Dalila, Barrera-Domínguez, Erick Daniel, Velasco-Campos, Francisco
• Format: Article
• Language: English
• Subjects: Centromedian thalamic nucleus; Drug Resistant Epilepsy - surgery; Electroencephalography; Generalized epilepsy; Humans; Intralaminar Thalamic Nuclei; Multifocal epilepsy; Pharmaceutical Preparations; Radiofrequency Ablation; Refractory epilepsy
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2020.107560

•Bilateral RFA of the CMN reduce the frequency of seizures in patients with refractory epilepsy.•It may improve neuropsychological deficits by reducing the frequency seizures.•It appears to be just as effective as other palliative epilepsy surgical methods. To determine the usefulness and efficacy of radiofrequency ablations (RFA) of the Centromedian thalamic nucleus (CMN) to control primarily generalized or multifocal seizures in refractory epilepsy. Six patients with clinical diagnosis of multifocal or primarily generalized drug-resistant epilepsy were included. Bilateral RFA of the CMN was performed through a monopolar 1.8 mm. tip electrode with a temperature of 80 °C during 90 seconds. Patients were followed in every 3 months visit for 20 to 36 months and kept a monthly seizure count calendar. We also compared maximal paroxysmal electroencephalogram (EEG) activity and neuropsychological evaluation pre and 6 months postoperatively. A significant reduction in the number of generalized seizures was observed in all subjects in the range of 79–98%, starting the first post-operative month. Although focal aware seizures remained unchanged throughout follow-up, there was an important reduction on paroxysmal activity between the pre and postoperative EEG. No major changes on cognitive status were detected. There was post-operative dysphagia and odynophagia lasting one week and there was no mortality in this group of patients. Preliminary results of CMN RFA suggest safety and a trend toward reduction of some seizure types, it may reduce the seizure frequency like other palliative procedures since the first post-operative month, but a larger, controlled study would be needed to establish the value of this therapy.