Systematic review and meta-analysis of standard vs selective temporal lobe epilepsy surgery

被引:228
作者
Josephson, Colin B. [1 ]
Dykeman, Jonathan [2 ,3 ]
Fiest, Kirsten M. [2 ,3 ]
Liu, Xiaorong [6 ,7 ]
Sadler, R. Mark [1 ]
Jette, Nathalie [2 ,3 ,4 ,5 ]
Wiebe, Samuel [2 ,3 ,4 ,5 ]
机构
[1] Dalhousie Univ, Dept Med, Div Neurol, Halifax, NS, Canada
[2] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada
[3] Univ Calgary, Hotchkiss Brain Inst, Calgary, AB, Canada
[4] Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada
[5] Univ Calgary, Inst Publ Hlth, Calgary, AB, Canada
[6] Guangzhou Med Univ, Key Lab Neurogenet & Channelopathies Guangdong Pr, Guangzhou, Guangdong, Peoples R China
[7] Guangzhou Med Univ, Minist Educ China, Inst Neurosci, Guangzhou, Guangdong, Peoples R China
关键词
SURGICAL-TREATMENT; HIPPOCAMPAL SCLEROSIS; AMYGDALOHIPPOCAMPECTOMY; SEIZURE; LOBECTOMY; COGNITION; OUTCOMES; COHORT; TRIAL;
D O I
10.1212/WNL.0b013e3182904f82
中图分类号
R74 [神经病学与精神病学];
学科分类号
100204 [神经病学];
摘要
Objective: To compare standard anterior temporal lobectomy (ATL) with selective amygdalohippocampectomy (SAH) for postoperative seizure control in temporal lobe epilepsy (TLE). Methods: We searched MEDLINE and Embase using Medical Subject Headings and keywords related to ATL and SAH. We included original research that directly compared seizure outcomes in patients undergoing SAH or ATL for TLE. A fixed-effect model was used to derive a pooled risk ratio (RR) for either an Engel Class I (free of disabling seizures) or a composite of an Engel Class I and II (rare disabling seizures) outcome. Results: Of 4,675 abstracts initially identified by the search, 65 were reviewed as full text. Thirteen studies containing data from 8 countries (5 continents) met our inclusion criteria. Eleven studies comprising 1,203 patients demonstrated that participants were statistically more likely to achieve an Engel Class I outcome after ATL compared with SAH (risk ratio 1.32, 95% confidence interval [CI] 1.12-1.57; p < 0.01). The summary risk difference of 8% (95% CI 3%-14%) translates to a number needed to treat of 13 (95% CI 7-33) for 1 additional patient to achieve an Engel Class I outcome after ATL. The result remained significant when 2 studies that contained fewer than 15 participants in at least 1 arm were excluded and in analyses restricted to hippocampal sclerosis. Conclusions: Standard ATL confers an improved chance of achieving freedom from disabling seizures in patients with TLE. Improved seizure freedom must be balanced against the neuropsychological impact of each procedure. A randomized controlled trial is justified.
引用
收藏
页码:1669 / 1676
页数:8
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