Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis.
Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis.
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DOI：
10.1093/neuros/nyx158
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发表时间：
2018-03-01
期刊：
影响因子：
4.8
通讯作者：
Englot DJ
中科院分区：
文献类型：
--
作者：
Harward SC;Chen WC;Rolston JD;Haglund MM;Englot DJ
枕叶癫痫（OLE）是一种罕见的但使人衰弱的局灶性癫痫综合征，癫痫发作通常难以治疗。虽然手术切除已被证明是一种可行的治疗方法，但之前检查术后癫痫发作无率的研究受到样本量小和患者异质性的限制，因此其结果存在显著差异。回顾关于OLE的医学文献，以研究手术后癫痫发作自由度和视力结局的发生率和预测因素。我们回顾了PubMed上1990年1月至2015年6月期间发表的探索耐药OLE手术切除的手稿。分析了癫痫发作的自由率，并通过单独的荟萃分析评估了潜在的预测因素。还检查了术后视力结果。我们确定了27个病例系列，包括584例随访超过1年的患者。术后无癫痫发作在65%的患者中观察到（Engel I级结局），并且年龄小于18岁显著预测（比值比[OR] 1.54，95%置信区间[CI] 1.13-2.18），病理分析中的局灶性病变（OR 2.08，95% CI 1.58-2.89）和术前磁共振成像异常（OR 3.24，95% CI 2.03-6.55）。在这些患者中，175例患者还报告了视力结局，其中57%的患者在手术后出现了一定程度的视力下降。我们没有发现术后视力和癫痫发作结果之间的任何关系。OLE的手术切除与良好的结局相关，近三分之二的患者术后无癫痫发作。但是，必须告知患者手术后视力下降的风险。
Occipital lobe epilepsy (OLE) is an uncommon but debilitating focal epilepsy syndrome with seizures often refractory to medical management. While surgical resection has proven a viable treatment, previous studies examining postoperative seizure freedom rates are limited by small sample size and patient heterogeneity, thus exhibiting significant variability in their results. To review the medical literature on OLE so as to investigate rates and predictors of both seizure freedom and visual outcomes following surgery. We reviewed manuscripts exploring surgical resection for drug-resistant OLE published between January 1990 and June 2015 on PubMed. Seizure freedom rates were analyzed and potential predictors were evaluated with separate meta-analyses. Postoperative visual outcomes were also examined. We identified 27 case series comprising 584 patients with greater than 1 yr of follow-up. Postoperative seizure freedom (Engel class I outcome) was observed in 65% of patients, and was significantly predicted by age less than 18 yr (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13–2.18), focal lesion on pathological analysis (OR 2.08, 95% CI 1.58–2.89), and abnormal preoperative magnetic resonance imaging (OR 3.24, 95% 2.03–6.55). Of these patients, 175 also had visual outcomes reported with 57% demonstrating some degree of visual decline following surgery. We did not find any relationship between postoperative visual and seizure outcomes. Surgical resection for OLE is associated with favorable outcomes with nearly two-thirds of patients achieving postoperative seizure freedom. However, patients must be counseled regarding the risk of visual decline following surgery.
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影响因子：
7
作者：
Huedo-Medina, Tania B.;Sanchez-Meca, Julio;Botella, Juan
通讯作者：
Botella, Juan
与局灶性新皮质癫痫手术失败有关的因素。
影响因子：
4.8
作者：
Englot DJ;Raygor KP;Molinaro AM;Garcia PA;Knowlton RC;Auguste KI;Chang EF
通讯作者：
Chang EF
影响因子：
6
作者：
Barba, C;Doglietto, F;Colicchio, G
通讯作者：
Colicchio, G
影响因子：
4.1
作者：
Binder, Devin K.;von Lehe, Marec;Clusmann, Hans
通讯作者：
Clusmann, Hans
影响因子：
5.6
作者：
Dalmagro, CL;Bianchin, MM;Sakamoto, AC
通讯作者：
Sakamoto, AC