Magnetic resonance–guided laser interstitial thermal therapy versus stereoelectroencephalography-guided radiofrequency thermocoagulation for drug-resistant epilepsy: A systematic review and meta-analysis

•The seizure-freedom rates after MRgLiTT and SEEG-RFTC are 65 % and 23 %, respectively.•The heterogeneity of MRgLiTT is reduced after grouping according to etiology.•The seizure-freedom rates of patients with hypothalamic hamartomas and temporal lobe epilepsy are 99 % and 59 %, respectively.•For those treated with SEEG-RFTC, patients with periventricular nodular heterotopias have the highest seizure-freedom rate (56 %).•Both treatments are safe methods, with low complication rate. Magnetic resonance–guided laser interstitial thermal therapy (MRgLiTT) is a minimally invasive treatment for drug-resistant epilepsies (DRE), and stereoelectroencephalography-guided radiofrequency thermocoagulation (SEEG-RFTC) is also reported as a minimally invasive treatment in some cases with DRE. This study aimed to undertake a meta-analysis to assess the effectiveness and safety of the two approaches in treating DRE. Databases, including PubMed, Embase, and Cochrane, were searched systematically up to November 2019. Our primary objective was to estimate the percentage of postoperative freedom from seizures and complications after MRgLiTT and SEEG-RFTC. The secondary objective was to estimate the rate of freedom from seizure after dividing the patients into groups according to the etiology of the epilepsy. Twenty-six studies, with a total number of 804 patients, were identified, 16 studies with MRgLiTT (414 patients) and 10 with SEEG-RFTC (390 patients). In total, significant difference was found in the postoperative rate of freedom from seizure between patients with MRgLiTT (65 %; 95 % CI 56–74 %) and those with SEEG-RFTC (23 %; 95 % CI 10–39 %) (P = 0.00), and there was high heterogeneity across groups. After dividing the patients according to etiology, those with MRgLiTT in both the hypothalamic hamartoma group (99 %; 95 % CI 92 %–100 %) and the temporal lobe epilepsy group (59 %; 95 % CI 53 %–65 %) achieved great efficacy and low heterogeneity, and patients with temporal lobe epilepsy and mesial temporal sclerosis (MTS) did not achieve better seizure control than non-MTS patients did (OR = 1.46; 95 % CI [0.88, 2.41]; P = 0.142). For the patients treated with SEEG-RFTC, those in the periventricular nodular heterotopias group obtained the highest percentage of freedom from seizure (56 %; 95 % CI 23 %–86 %). The overall complication rate across all samples was low in the two approaches (5%; 95 % CI 3%–8%). MRgLiTT and SEEG-RFTC are both safe, minimally invasive treatments fo