SEEG Guided RF-TC v.s. ATL for mTLE With HS
SEEG Guided RF-TC v.s. ATL for mTLE With HS
Mesial temporal lobe epilepsy (mTLE) is the most classical subtype of temporal lobe epilepsy,
 which is the indication of surgical intervention after evaluation. Until now, anterior
 temporal lobectomy (ATL) is still the recommended treatment for mTLE. However, evidences are
 accumulated including post ATL tetartanopia and memory deterioration and new minimized
 invasive treatments are introduced. Stereotactic EEG (SEEG) guided radio-frequency
 thermocoagulation (RF-TC) is one of the option with lower seizure freedom but with higher
 neurological function reservation. This study is aiming at comparison of the efficacy and
 safety between SEEG guided RF-TC and classical ATL in the treatment of mTLE.
Nowadays, more and more patients received SEEG implantation for the evaluation of intractable
 seizures. SEEG is not only a diagnostic method to locate the origin of the epileptic seizures
 but also a media to treat or to cure this disease. Using radiofrequency thermocoagulation, we
 are able to coagulate some part of the brain guided by SEEG. However, until now, we don't
 have high level evidence for the efficacy and safety of RF-TC. In our resent series, we found
 the 1 year seizure free rate of mTLE patients after RF-TC is about 80% without any notable
 complication.

 In this trail, we will compare the efficacy as well as the safety of anterior temporal
 lobectomy with RF-TC for the mTLE patients, including the 1 year Engel class, perioperative
 complications, cognitive function, visual field, etc. Thus we can provide more high level
 evidence on the usage of SEEG guided RF-TC on mTLE patients.
Inclusion Criteria:

 Clinical diagnosis of drug resistant epilepsy

 At least one or more anti-epileptic drugs (AEDs) regular administered for more than 2
 years, one of which was either Dilantin, Tegretol, Carbatrol, or Trileptal used in
 appropriate doses, have failed due to inefficacy, not intolerance

 Persistence of disabling seizures at least 3 times per 3 months or greater, and once or
 more in recent 1 month

 14 years or older at enrollment

 Simple and complex partial seizures, with or without secondarily generalized seizures
 beginning in childhood or later, with or without febrile convulsions earlier

 Auras that occur in isolation and are not primary sensory other than olfactory or gustatory

 I.Q. of greater than 70

 Hippocampal atrophy on MRI T1 imaging with increased ipsilateral mesial signal on T2
 imaging

 Interictal EEG shows focal or lateralized spikes on temporal, frontal zone, or sphenoid
 electrode

 Ictal EEG onset is focal or lateralized on the ipsilateral side

 Ipsilateral temporal focal hypometabolism on PET

 Must be agreed by a consensus of ipsilateral mesial temporal origin by a multidisciplinary
 discussion

 Must be able to understand and speak Mandarin

 Exclusion criteria:

 A history of serious cerebral insult after the age of 5

 A progressive neurological disorder; mental retardation (I.Q. less than 70)

 Psychogenic seizures

 Focal neurological deficits other than memory disturbances

 Any unexplained focal or lateralized neurological deficits other than memory dysfunction.

 Temporal neocortical or extratemporal lesions on MRI

 Psychosis, current or recent substance abuse, suicidality, anorexia, or psychogenic
 seizures

 Severe systemic diseases

 Unequivocal focal extratemporal EEG slowing or interictal spikes

 Lesions on MRI outside of the mesial temporal area

 Diffuse unilateral or bilateral hypometabolism on positron emission tomography (PET)

 Contralateral or extratemporal ictal onset

 Persistent extratemporal, or predominant contralateral focal interictal spikes or slowing,
 or generalized interictal spikes

 Patient who was included in any clinical trial

 Pregnancy