A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia Clinical article

被引:156
作者
Rowland, Nathan C. [1 ]
Englot, Dario J. [1 ]
Cage, Tene A. [1 ]
Sughrue, Michael E. [1 ]
Barbaro, Nicholas M. [1 ]
Chang, Edward F. [1 ]
机构
[1] Univ Calif San Francisco, Dept Neurol Surg, UCSF Comprehens Epilepsy Ctr, San Francisco, CA 94143 USA
关键词
focal cortical dysplasia; meta-analysis; epilepsy surgery; NEURONAL MIGRATION DISORDERS; INTRACTABLE PARTIAL EPILEPSY; PEDIATRIC EPILEPSY; SURGERY; CHILDREN; CLASSIFICATION; MALFORMATIONS; FEATURES; SUBTYPES; OUTCOMES;
D O I
10.3171/2012.1.JNS111105
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. Focal cortical dysplasia (FCD) is one of the most common causes of medically refractory epilepsy leading to surgery. However, seizure control outcomes reported in isolated surgical series are highly variable. As a result, it is not clear which variables are most crucial in predicting seizure freedom following surgery for FCD. The authors' aim was to determine the prognostic factors for seizure control in FCD by performing a meta-analysis of the published literature. Methods. A MEDLINE search of the published literature yielded 37 studies that met inclusion and exclusion criteria. Seven potential prognostic variables were determined from these studies and were dichotomized for analysis. For each variable, individual studies were weighted by inverse variance and combined to generate an odds ratio favoring seizure freedom. The methods complied with a standardized meta-analysis reporting protocol. Results. Two thousand fourteen patients were included in the analysis. The overall rate of seizure freedom (Engel Class 1) among patients undergoing surgery for FCD in the cohort of studies was 55.8% +/- 16.2%. Partial seizures, a temporal location, detection with MRI, and a Type II Palmini histological classification were associated with higher rates of postoperative seizure control. As a treatment-related factor, complete resection of the anatomical or electrographic abnormality was the most important predictor overall of seizure freedom. Neither age nor electroencephalographic localization of the ictal onset significantly affected seizure freedom after surgery. Conclusions. Using a large population cohort pooled from the published literature, an analysis identified important factors that are prognostic in patients with epilepsy due to FCD. The most important of these factors diagnostic imaging and resection provide modalities through which improvements in the impact of FCD can be effected. (http://thejns.org/doi/abs/10.3171/2012.1.JNS111105)
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收藏
页码:1035 / 1041
页数:7
相关论文
共 62 条
[1]   Seizure outcome after surgery for epilepsy due to focal cortical dysplastic lesions [J].
Alexandre, Veriano, Jr. ;
Walz, Roger ;
Bianchin, Marino M. ;
Velasco, Tonicarlo R. ;
Terra-Bustamante, Vera C. ;
Wichert-Ana, Lauro ;
Araujo, David, Jr. ;
Machado, Helio R. ;
Assirati, Joao A., Jr. ;
Carlotti, Carlos G., Jr. ;
Santos, Antonio C. ;
Serafini, Luciano N. ;
Sakamoto, Americo C. .
SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 2006, 15 (06) :420-427
[2]  
[Anonymous], PRACTICAL METAANALYS
[3]  
[Anonymous], 1993, SURG TREATMENT EPILE
[4]   A developmental and genetic classification for malformations of cortical development [J].
Barkovich, AJ ;
Kuzniecky, RI ;
Jackson, GD ;
Guerrini, R ;
Dobyns, WB .
NEUROLOGY, 2005, 65 (12) :1873-1887
[5]   Focal cortical dysplasia: prevalence, clinical presentation and epilepsy in children and adults [J].
Bast, T ;
Ramantani, G ;
Seitz, A ;
Rating, D .
ACTA NEUROLOGICA SCANDINAVICA, 2006, 113 (02) :72-81
[6]   Focal cortical dysplasia and intractable epilepsy in adults:: clinical, EEG, imaging, and surgical features [J].
Bautista, JF ;
Foldvary-Schaefer, N ;
Bingaman, WE ;
Lüders, HO .
EPILEPSY RESEARCH, 2003, 55 (1-2) :131-136
[7]   The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission [J].
Bluemcke, Ingmar ;
Thom, Maria ;
Aronica, Eleonora ;
Armstrong, Dawna D. ;
Vinters, Harry V. ;
Palmini, Andre ;
Jacques, Thomas S. ;
Avanzini, Giuliano ;
Barkovich, A. James ;
Battaglia, Giorgio ;
Becker, Albert ;
Cepeda, Carlos ;
Cendes, Fernando ;
Colombo, Nadia ;
Crino, Peter ;
Cross, J. Helen ;
Delalande, Olivier ;
Dubeau, Francois ;
Duncan, John ;
Guerrini, Renzo ;
Kahane, Philippe ;
Mathern, Gary ;
Najm, Imad ;
Ozkara, Cigdem ;
Raybaud, Charles ;
Represa, Alfonso ;
Roper, Steven N. ;
Salamon, Noriko ;
Schulze-Bonhage, Andreas ;
Tassi, Laura ;
Vezzani, Annamaria ;
Spreafico, Roberto .
EPILEPSIA, 2011, 52 (01) :158-174
[8]   Malformations of cortical development and epilepsies: neuropathological findings with emphasis on focal cortical dysplasia [J].
Bluemcke, Ingmar ;
Vinters, Harry V. ;
Armstrong, Dawna ;
Aronica, Eleonora ;
Thom, Maria ;
Spreafico, Roberto .
EPILEPTIC DISORDERS, 2009, 11 (03) :181-193
[9]  
Brannstrom T, 1996, DYSPLASIAS OF CEREBRAL CORTEX AND EPILEPSY, P57
[10]   Predictors of Seizure Freedom after Surgery for Malformations of Cortical Development [J].
Chang, Edward F. ;
Wang, Doris D. ;
Barkovich, A. James ;
Tihan, Tarik ;
Auguste, Kurtis I. ;
Sullivan, Joseph E. ;
Garcia, Paul A. ;
Barbaro, Nicholas M. .
ANNALS OF NEUROLOGY, 2011, 70 (01) :151-162