Authors :
Presenting Author: Riju Dahal, MD, PhD – Annapurna Neurological Institute
Pritam Gurung, MD, PhD – Annapurna Neurological Institute
Resha Shrestha, MS – Annapurna Neurological Institute
Raju Dhungel, BS – Annapurna Neurological Institute
Januka Dhamala, BS – Annapurna Neurological Institute
Basant Pant, MD, PhD – Annapurna Neurological Institute
Rationale:
To evaluate seizure and cognitive outcomes following single, bilateral, or multitarget stereotactic radiofrequency ablation (RFA) of thalamic nuclei in patients with drug-resistant epilepsy (DRE).
Methods:
Nine patients with DRE underwent stereotactic RFA targeting the anterior nucleus (ANT), centromedian nucleus (CMN), and/or pulvinar, based on seizure semiology, video-EEG or stereo-EEG, and MRI findings. ANT was selected for frontotemporal seizures, CMN for generalized or multifocal seizures, and pulvinar for posterior onset. RFA was performed using a monopolar electrode (0.75 mm diameter, 2 mm tip exposure) at 75°C for 60 seconds. Seizure frequency and cognitive status were assessed during follow-up.
Results:
Six patients underwent ANT RFA (four bilateral, two unilateral), one underwent bilateral CMN RFA, and two received unilateral multitarget RFA (ANT+CMN and CMN+pulvinar). All patients demonstrated seizure reduction within the first postoperative month. The most favorable outcomes were seen in those with ANT RFA: four patients achieved seizure freedom at one year, and two had >50% reduction. Both multitarget cases showed >50% seizure reduction at >6 months. The patient with bilateral CMN RFA had >50% reduction at 3 months and notable improvement in spasticity. Standardized cognitive assessments before and after surgery revealed no new deficits, except in one patient with tumor recurrence. No complications were attributed to the procedure.Conclusions:
Single, bilateral and multitarget thalamic RFA were safe and led to early seizure reduction. The best outcomes were seen in patients who underwent ANT RFA, likely because these patients had well-localized frontotemporal seizures. Multitarget RFA was also effective, with significant seizure reduction in patients who had multifocal or more complex seizure networks, though complete seizure freedom was not achieved. Bilateral CMN ablation resulted in >50% seizure reduction and also improved spasticity, an important clinical observation. No cognitive deficits were found on standardized testing, supporting the safety of thalamic RFA in carefully selected patients with DRE.
Funding: No.