背景:目前在神经外科肿瘤患者中尚无预防癫痫发作的正式适应症。对于计划手术的无癫痫脑膜瘤患者,也没有提出使用抗癫痫药物(AED)的具体建议。AED通常是酌情规定的,考虑到一系列临床和放射学风险因素。我们提出了一项系统的综述和荟萃分析,探讨了在无癫痫发作史的脑膜瘤患者中预防抗癫痫的有效性。
方法:我们对PubMed/MEDLINE进行了系统评价,Cochrane中央控制试验登记册,Embase,和clinicaltrials.gov数据库。在最初确定的4368项研究中,选取12例进行数据提取和定性分析。根据提供的临床数据,我们仅能够将6项研究纳入荟萃分析.我们进行了异质性研究,计算出一个综合赔率比,评估出版偏见,并进行了敏感性分析。
结果:与对照组相比,脑膜瘤且无癫痫发作史的患者预防AED并未显着降低术后癫痫发作的发生率(Mantel-Haenszel联合比值比,随机效应模型:1.26[95%置信区间,0.60-2.78];2041例患者)。然而,由于缺乏前瞻性研究,我们无法建立针对这种治疗的有力建议,在审查的研究中存在选择偏差,在随访期间低估癫痫发作频率的可能性,以及一项研究对整体效果的强烈影响。
结论:尽管本综述有局限性,荟萃分析的结果不支持脑膜瘤患者常规使用预防癫痫发作,且无癫痫发作史.
BACKGROUND: No formal indication currently exists for seizure prophylaxis in neurosurgical oncology patients. Neither have specific recommendations been made on the use of antiepileptic drugs (AED) in seizure-free patients with meningiomas scheduled for surgery. AEDs are generally prescribed on a discretionary basis, taking into consideration a range of clinical and radiological risk factors. We present a systematic review and meta-analysis exploring the effectiveness of antiepileptic prophylaxis in patients with meningioma and no history of seizures.
METHODS: We performed a systematic review of the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and clinicaltrials.gov databases. Of a total of 4368 studies initially identified, 12 were selected for extraction of data and qualitative analysis. Based on the clinical data presented, we were only able to include 6 studies in the meta-analysis. We performed heterogeneity studies, calculated a combined odds ratio, evaluated publication bias, and conducted a sensitivity analysis.
RESULTS: AED prophylaxis in patients with meningioma and no history of seizures did not significantly reduce the incidence of post-operative seizures in comparison to controls (Mantel-Haenszel combined odds ratio, random effects model: 1.26 [95% confidence interval, 0.60-2.78]; 2041 patients). However, we are unable to establish a robust recommendation against this treatment due to the lack of prospective studies, the presence of selection bias in the studies reviewed, the likelihood of underestimation of seizure frequency during follow-up, and the strong influence of one study on the overall effect.
CONCLUSIONS: Despite the limitations of this review, the results of the meta-analysis do not support the routine use of seizure prophylaxis in patients with meningioma and no history of seizures.