A recent systematic review compared the effectiveness and safety of two surgical interventions for adults with drug-resistant temporal lobe epilepsy (TLE): stereoelectroencephalography (SEEG)-guided temporal lobe resection (TLR) and SEEG-guided responsive neurostimulation (RNS). TLE is the most common type of focal epilepsy, often leading to drug resistance in a significant number of patients.
The review, conducted according to PRISMA 2020 guidelines, analyzed studies published between January and February 2025. It included adult patients who had undergone either SEEG-guided TLR or RNS after preoperative localization using SEEG. The main outcomes assessed were seizure freedom, reduction in seizures, adverse events, and improvements in quality of life (QoL). Quality assessments used established tools such as the Cochrane Risk of Bias Tool for randomized trials and the Newcastle-Ottawa Scale for observational studies.
Fifteen studies met the inclusion criteria, with sample sizes ranging from 10 to 440 participants. The review found that SEEG-guided TLR generally led to higher rates of seizure freedom and reduction compared to RNS. However, TLR carries a risk of cognitive decline—particularly when surgery involves the dominant hemisphere. On the other hand, RNS was associated with meaningful reductions in seizures while better preserving cognitive function. This makes RNS an important option for patients with bilateral seizure onset, involvement of critical brain regions (eloquent cortex), or those who have not benefited from previous resections.
The authors noted that direct comparisons between TLR and RNS are complicated by differences in patient populations; for example, those receiving RNS often have more complex clinical cases. Both treatments were shown to improve quality of life, but methods for assessing QoL varied across studies. The report emphasized that treatment decisions should be tailored to each patient’s situation by weighing factors such as seizure control potential, cognitive risks, and individual preferences.
Most evidence came from observational studies rather than randomized controlled trials—only two such trials were identified—which limits how strongly conclusions can be drawn about comparative efficacy. Additionally, inconsistent definitions and reporting methods further complicate data synthesis.
The review concluded: "SEEG-guided TLR and RNS are both effective and safe interventions for drug-resistant TLE, with distinct profiles: TLR offers higher seizure freedom, while RNS preserves cognitive function. Treatment should be personalized based on patient-specific factors, including seizure localization, cognitive risks, and QoL priorities. Future studies should prioritize long-term outcomes and refined patient selection criteria to optimize epilepsy care."
