The role of high-frequency oscillations in epilepsy surgery planning.
The role of high-frequency oscillations in epilepsy surgery planning.
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DOI：
10.1002/14651858.cd010235.pub2
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发表时间：
2014-01-15
影响因子：
8.4
通讯作者：
Staba, Richard
中科院分区：
文献类型：
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作者：
Gloss, David;Nolan, Sarah J.;Staba, Richard
癫痫是一种严重的脑部疾病，其特征是经常性的无端癫痫发作。大约三分之二的癫痫发作可以用抗癫痫药物控制。对于其他一些人，手术可以完全消除或显着减少致残性癫痫发作的发生。切除手术的致痫区定位还远未完善，正在研究新的工具以更准确地定位致痫区（癫痫开始的大脑区域）并提高术后癫痫发作的可能性。病理性高频振荡（HFO）的记录可能是这样一种工具。评估HFO通过帮助更准确地识别大脑致癫痫区域来改善癫痫手术结果的能力。我们检索了科克伦Epilepsy Group Specialized Register（2013年4月15日）、科克伦Library中的Cochrane Central Register of Controlled Trials（CENTRAL）（2013年第3期）、MEDLINE（奥维德）（1946年至2013年4月15日）、CINAHL（EBSCOhost）（2013年4月15日）、Web of Knowledge（Thomson路透社）（2013年4月15日）、www.clinicaltrials.gov（2013年4月15日）和世界卫生组织国际临床试验注册平台（2013年4月15日）。我们纳入的研究提供了至少6个月的癫痫手术结局信息，并在癫痫手术决策中使用高频振荡。该综述的主要结局是恩格尔等级结局系统。次要结局为应答率、国际抗癫痫联盟（ILAE）癫痫手术结局、任何来源的不良事件频率和生活质量结局。我们打算通过汇总数据固定效应模型荟萃分析来分析结果。2项研究符合纳入标准。这两项研究都是小型非随机试验，没有对照组，也没有设盲。所有结果的证据质量都很低。这两项研究的结合导致11名参与者前瞻性地使用发作期HFO进行癫痫手术决策。在12至38个月（平均23.4个月）内确定了术后无癫痫发作Engel I至IV级结局的结果，并表明6名参与者具有Engel I级结局（无癫痫发作），2名具有II级结局（罕见致残性癫痫发作），3名具有III级结局（值得改善）。未报告不良反应。两项研究均未对HFO引导的手术结果与无HFO引导的手术结果进行比较。目前，关于在癫痫手术决策中使用HFO的有效性还没有可靠的结论。
Epilepsy is a serious brain disorder characterized by recurrent unprovoked seizures. Approximately two-thirds of seizures can be controlled with antiepileptic medications. For some of the others, surgery can completely eliminate or significantly reduce the occurrence of disabling seizures. Localization of epileptogenic areas for resective surgery is far from perfect, and new tools are being investigated to more accurately localize the epileptogenic zone (the zone of the brain where the seizures begin) and improve the likelihood of freedom from postsurgical seizures. Recordings of pathological high-frequency oscillations (HFOs) may be one such tool. To assess the ability of HFOs to improve the outcomes of epilepsy surgery by helping to identify more accurately the epileptogenic areas of the brain. We searched the Cochrane Epilepsy Group Specialized Register (15 April 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 3), MEDLINE (Ovid) (1946 to 15 April 2013), CINAHL (EBSCOhost) (15 April 2013), Web of Knowledge (Thomson Reuters) (15 April 2013), www.clinicaltrials.gov (15 April 2013), and the World Health Organization International Clinical Trials Registry Platform (15 April 2013). We included studies that provided information on the outcomes of epilepsy surgery at at least six months and which used high-frequency oscillations in making decisions about epilepsy surgery. The primary outcome of the review was the Engel Class Outcome System. Secondary outcomes were responder rate, International League Against Epilepsy (ILAE) epilepsy surgery outcome, frequency of adverse events from any source and quality of life outcomes. We intended to analyse outcomes via an aggregated data fixed-effect model meta-analysis. Two studies met the inclusion criteria. Both studies were small non-randomised trials, with no control group and no blinding. The quality of evidence for all outcomes was very low. The combination of these two studies resulted in 11 participants who prospectively used ictal HFOs for epilepsy surgery decision making. Results of the postsurgical seizure freedom Engel class I to IV outcome were determined over a period of 12 to 38 months (average 23.4 months) and indicated that six participants had an Engel class I outcome (seizure freedom), two had class II (rare disabling seizures), three had class III (worthwhile improvement). No adverse effects were reported. Neither study compared surgical results guided by HFOs versus surgical results guided without HFOs. No reliable conclusions can be drawn regarding the efficacy of using HFOs in epilepsy surgery decision making at present.