Surgery for epilepsy

摘要: Background Focal epilepsies are caused by a malfunction of nerve cells localised in one part cerebral hemisphere. In studies, estimates the number individuals with focal epilepsy who do not become seizure-free despite optimal drug therapy vary according to age participants and which included, but have been reported as at least 20% some studies up 70%. If epileptogenic zone can be located surgical resection offers chance cure corresponding increase quality life. Objectives The primary objective is assess overall outcome surgery evidence from randomised controlled trials. The secondary objectives non-randomised identify factors that correlate remission seizures postoperatively. Search methods We searched Cochrane Epilepsy Group Specialised Register (June 2013), Central Controlled Trials (CENTRAL 2013, Issue 6), MEDLINE (Ovid) (2001 4 July ClinicalTrials.gov World Health Organization (WHO) International Clinical Registry Platform (ICTRP) for relevant trials 2013. Selection criteria Eligible were (RCTs), cohort or case series, either prospective and/or retrospective design, including 30 participants, well-defined population (age, sex, seizure type/frequency, duration epilepsy, aetiology, magnetic resonance imaging (MRI) diagnosis, findings), an MRI performed 90% cases expected follow-up year, reporting relating postoperative control. Data collection analysis Three groups two review authors independently screened all references eligibility, assessed study risk bias, extracted data. Outcomes proportion achieving good presence absence each prognostic factor interest. We intended combine data ratios (RR) 95% confidence intervals. Main results We identified 177 (16,253 participants) investigating epilepsy. Four RCTs (including medical treatment). The bias was unclear high, limiting our addressed objective. Most remaining 173 had design; they variable size, conducted range countries, recruited wide demographic used techniques different scales measure outcomes. assessment using Effective Public Practice Project (EPHPP) tool determined most provided moderate weak evidence. For 29 multivariate analyses we Quality Prognostic Studies (QUIPS) very few low across domains. In terms freedom seizures, RCT found superior treatment, no statistically significant difference between anterior temporal lobectomy (ATL) without corpus callosotomy 2.5 cm 3.5 ATL resection, total hippocampectomy partial hippocampectomy. judged four due lack information about trial design restricted populations. Of 16,253 included this review, 10,518 (65%) achieved surgery; ranged 13.5% 92.5%. Overall, relation recording adverse events poor. In total, 118 examined eight univariate analysis. following associated better post-surgical outcome: abnormal pre-operative MRI, use intracranial monitoring, complete mesial sclerosis, concordance electroencephalography (EEG), history febrile cortical dysplasia/malformation development, tumour, right-sided unilateral interictal spikes. head injury, encephalomalacia, vascular malformation discharges outcome. observed variability many analyses, likely small sizes unbalanced group sizes, variation definition outcome, influence site surgery, related Twenty-nine multivariable models direction association generally same analyses. However, analysis approaches selective results, meaningful comparison meta-analysis difficult. Authors' conclusions The issues limited presented mean results provide aid patient selection prediction Future research should high quality, appropriately powered focus on specific diagnostic tools, site-specific approach other such extent resection. investigated via statistical regression modelling, where variables selected modelling clinical relevance numerical fully reported. Protocols include pre- measures speech language function, cognition social functioning along mental state assessment. Journal editors accept papers intervention recorded. Improvements development cancer care over past three decades answering questions through conduct focused step-wise fashion. required.