Abstract:
Epilepsy surgery provides excellent benefits in post-traumatic epilepsy of the temporal lobe (PTE-TL), but outcomes relative to non-traumatic epilepsy of the temporal lobe (NTE-TL) are less favorable. Large well-designed studies are recommended to further clarify the role of epilepsy surgery in PTE. It is unclear whether epilepsy surgery outcomes in PTE are as robust as described for drug resistant epilepsy (DRE) in general. Prior outcome studies in PTE are limited by small numbers, lack of a control group, or both. We performed a meta-analysis of studies in temporal lobe epilepsy (TLE) to evaluate post-surgical outcomes in those with PTE-TL and compare outcomes to those with NTE-TL. PubMed, EMBASE, and Web of Science databases were queried for studies reporting epilepsy surgery outcomes separately for PTE-TL and NTE-TL. Outcomes were divided into favorable (Engel Class I) or unfavorable (Engel Class II-IV) for comparison. Meta-analyses were performed to evaluate: 1) the proportion of Class I outcomes following epilepsy surgery in PTE-TL; and 2) calculate the odds of Class I surgical outcomes in PTE-TL compared with NTE-TL. Of 3669 articles that reported surgical outcomes in epilepsy, nine studies (n = 886) were identified that reported outcomes for both PTE-TL (n = 219) and NTE-TL (n = 667). The weighted proportion of favorable outcomes (Engel Class I) were high for both PTE-TL (70.1%, 95% CI 61.9%-78.3%) and NTE-TL (75.2%, 95% CI 69.4%-80.2%). Patients with PTE-TL were at greater risk of unfavorable (Engel Class II-IV) outcomes (relative risk 1.36, 95% CI 1.04-1.78) compared with NTE-TL.
摘要:
癫痫手术在PTE-TL中提供了极好的益处,但相对于NTE-TL的结果不太有利。建议进行大型精心设计的研究,以进一步阐明癫痫手术在PTE中的作用。目前尚不清楚创伤后癫痫(PTE)的癫痫手术结果是否与耐药性癫痫(DRE)的总体描述相同。PTE的先前结局研究受到数量少的限制,缺少对照组,或者两者兼而有之。我们对颞叶癫痫(TLE)的研究进行了荟萃分析,以评估PTE患者(PTE-TL)的术后结局,并将其与非创伤性癫痫患者(NTE-TL)的结局进行比较。PubMed,EMBASE,和WebofScience数据库被查询为分别报告PTE-TL和NTE-TL癫痫手术结局的研究。结果分为有利(EngelI类)或不利(EngelII-IV类)进行比较。进行荟萃分析以评估(1)PTE-TL中癫痫手术后I类结局的比例,以及(2)计算PTE-TL与NTE-TL相比I类手术结局的几率。在3669篇报道癫痫手术结果的文章中,确定了9项研究(n=886),报告了PTE-TL(n=219)的结果,和NTE-TL(n=667)。PTE-TL的有利结果(EngelI类)加权比例均较高(70.1%,95%CI61.9%-78.3%)和NTE-TL(75.2%,95%CI69.4%-80.2%)。与NTE-TL相比,PTE-TL患者的不良结局(EngelII-IV级)风险更高(相对风险1.36,95%CI1.04-1.78)。关键词:创伤后癫痫,颞叶癫痫,手术结果,Meta分析,系统审查。