目的:总结遗传性难治性癫痫的手术结果并确定这些结果的预后因素。
方法:PubMed的文献检索,WebofScience,和相关研究的Embase数据库,在2002年1月1日至2023年12月31日之间发布,使用特定的搜索词进行.包括所有涉及遗传性难治性癫痫的手术结果和随访的研究。所有统计分析均使用STATA软件(StataCorpLLC,学院站,TX,美国)。本综述是根据系统评价和荟萃分析的首选报告项目进行的。2020年(即,“PRISMA”)报告准则。
结果:在检索到的3833项研究中,55符合纳入标准。8项研究符合研究水平的荟萃分析条件。汇总结果显示,接受切除手术的患者中有74%(95%置信区间[CI]0.55-0.89;z=9.47,p<0.05)在最后一次随访时达到了EngelI状态。在学习水平分析中,汇总结果显示,接受迷走神经刺激的患者中有9%达到无癫痫发作状态(95%CI0.00-0.31;z=1.74,p<0.05),61%(95%CI0.55-0.89;z=11.96,p<0.05)在最后一次随访时癫痫发作频率降低了50%。包括249名患者的53项研究被纳入个体水平分析。在接受病变切除术或肺叶切除术/多叶切除术的患者中,65%(100/153)在最后一次随访中达到EngelI状态。单因素分析表明,女性性别,体细胞突变,出现局灶性癫痫发作症状与更好的预后相关(p<0.05)。此外,75%(21/28)接受大脑半球切除术/大脑半球切开术的患者在最后一次随访时达到了EngelI状态。在个人层面的分析中,在接受迷走神经刺激治疗的患者中,21%(10/47)的患者无癫痫发作,64%(30/47)的患者癫痫发作频率与基线相比减少了>50%。
结论:精心的术前评估和选择合适的手术方式可以,在某种程度上,有效控制癫痫发作。因此,治疗遗传性难治性癫痫患者时,应考虑各种外科手术。
OBJECTIVE: To summarize the surgical outcomes of genetically refractory epilepsy and identify prognostic factors for these outcomes.
METHODS: A literature search of the PubMed, Web of Science, and Embase databases for relevant studies, published between January 1, 2002 and December 31, 2023, was performed using specific search terms. All studies addressing surgical outcomes and follow-up of genetically refractory epilepsy were included. All statistical analyses were performed using STATA software (StataCorp LLC, College Station, TX, USA). This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2020 (i.e., \"PRISMA\") reporting guidelines.
RESULTS: Of the 3833 studies retrieved, 55 fulfilled the inclusion criteria. Eight studies were eligible for meta-analysis at the study level. Pooled outcomes revealed that 74 % of patients who underwent resective surgery (95 % confidence interval [CI] 0.55-0.89; z = 9.47, p < 0.05) achieved Engel I status at the last follow-up. In the study level analysis, pooled outcomes revealed that 9 % of patients who underwent vagus nerve stimulation achieved seizure-free status (95 % CI 0.00-0.31; z = 1.74, p < 0.05), and 61 % (95 % CI 0.55-0.89; z = 11.96, p < 0.05) achieved a 50 % reduction in seizure frequency at the last follow-up. Fifty-three studies comprising 249 patients were included in an individual-level analysis. Among patients who underwent lesion resection or lobectomy/multilobar resection, 65 % (100/153) achieved Engel I status at the last follow-up. Univariate analysis indicated that female sex, somatic mutations, and presenting with focal seizure symptoms were associated with better prognosis (p < 0.05). Additionally, 75 % (21/28) of patients who underwent hemispherectomy/hemispherotomy achieved Engel I status at the last follow-up. In the individual-level analysis, among patients treated with vagus nerve stimulation, 21 % (10/47) were seizure-free and 64 % (30/47) experienced >50 % reduction in seizure frequency compared with baseline.
CONCLUSIONS: Meticulous presurgical evaluation and selection of appropriate surgical procedures can, to a certain extent, effectively control seizures. Therefore, various surgical procedures should be considered when treating patients with genetically refractory epilepsy.