Multiple Subpial Transections for Medically Refractory Epilepsy: A Disaggregated Review of Patient-Level Data.
Multiple Subpial Transections for Medically Refractory Epilepsy: A Disaggregated Review of Patient-Level Data.
复制标题
医学上难治性癫痫的多次软膜下横切术：患者数据的分类审查。
DOI：
10.1093/neuros/nyx311
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发表时间：
2018
期刊：
影响因子：
4.8
通讯作者：
Chang,EdwardF
中科院分区：
文献类型：
--
作者：
Rolston,JohnD;Deng,Hansen;Wang,DorisD;Englot,DarioJ;Chang,EdwardF
方法从Medline和PubMed数据库中提取描述MST手术患者水平数据的数据，从34项研究中产生212名患者的合成队列。结果55.2%的MST联合手术患者和23.9%的单纯MST患者获得了自主自主。发作缓解的重要预测因素是颞叶病灶(优势比4.9；95%可信区间1.71，14.3)和部分病灶切除(优势比3.88，95%可信区间2.02，7.45)。并发症较多，其中短暂性单侧或偏瘫19.8%，短暂性言语障碍12.3%，永久性轻瘫或言语障碍分别为6.6%和1.9%。结论MST是治疗功能区难治性癫痫的有效方法，部分病灶切除联合MST可获得更大的癫痫缓解机会。据报道，MST的癫痫缓解率高于现有的神经调节疗法，如迷走神经刺激、脑深部刺激和反应性神经刺激，尽管后一种疗法得到了随机对照试验的支持，而MST没有。报道的MST并发症发生率高于切除和神经调节治疗。如果进行了仔细的风险-收益分析，MST仍然是治疗有说服力的病灶的可行选择。
METHODSStudies describing patient-level data for MST procedures were extracted from the Medline and PubMed databases, yielding a synthetic cohort of 212 patients from 34 studies. Data regarding seizure outcome, patient demographics, seizure type, surgery type, and complications were extracted and analyzed.RESULTSSeizure freedom was achieved in 55.2% of patients undergoing MST combined with resection, and 23.9% of patients undergoing MST alone. Significant predictors for seizure freedom were a temporal lobe focus (odds ratio 4.9; 95% confidence interval 1.71, 14.3) and resection of portions of the focus, when feasible (odds ratio 3.88; 95% confidence interval 2.02, 7.45). Complications were frequent, with transient mono-or hemiparesis affecting 19.8% of patients, transient dysphasia 12.3%, and permanent paresis or dysphasia in 6.6% and 1.9% of patients, respectively.CONCLUSIONMST is an effective treatment for refractory epilepsy in eloquent cortex, with greater chances of seizure freedom when portions of the focus are resected in tandem with MST. The reported rates of seizure freedom with MST are higher than those of existing neuromodulatory therapies, such as vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation, though these latter therapies are supported by randomized-controlled trials, while MST is not. The reported complication rate of MST is higher than that of resection and neuromodulatory therapies. MST remains a viable option for the treatment of eloquent foci, provided a careful risk-benefit analysis is conducted.