• Neurosurgery · Nov 2022

    Meta Analysis

    Seizure Outcome of Temporal Lobe Epilepsy Surgery in Adults and Children: A Systematic Review and Meta-Analysis.

    • Carmen Barba, Sabrina Giometto, Ersilia Lucenteforte, Simona Pellacani, Giulia Matta, Alessandra Bettiol, Sara Minghetti, Lavinia Falorni, Federico Melani, Gianpiero Di Giacomo, Flavio Giordano, Salvatore De Masi, and Renzo Guerrini.
    • Neuroscience Department, Meyer Children's Hospital, Florence, Italy.
    • Neurosurgery. 2022 Nov 1; 91 (5): 676683676-683.

    BackgroundTemporal lobe epilepsy (TLE) surgery is associated with the best seizure outcome in adults, although its long-term results remain suboptimal. Retrospective pediatric studies suggest better figures whose determinants are poorly understood.ObjectiveTo conduct a systematic review and meta-analysis of studies on the efficacy of TLE surgery in children (age younger than 18 years) and adults.MethodsWe searched MEDLINE, Embase, and Cochrane Library for TLE surgery original research from January 1, 1990, until May 12, 2020. The outcome measures were seizure freedom since surgery and seizure freedom either at last or longest follow-up. We meta-analyzed the proportion of children and adults achieving either Engel I/International League Against Epilepsy (ILAE) 1 or Engel IA/ILAE 1A outcome by follow-up duration, type of surgery, histopathology, neuroimaging, quality of the studies, and publication period. We used a random effects model with Freeman-Tukey double arcsine transformation of proportions.ResultsFrom 40 409 records identified, we included 277 studies (30 848 patients). The proportions of patients achieving Engel I/ILAE 1 and Engel IA/ILAE 1A outcomes were 0.74 (95% CI, 0.69-0.78) and 0.61 (0.48-0.74) for children and 0.69 (0.67-0.71) and 0.56 (0.52-0.60) for adults. Histopathology significantly influenced Engel I/ILAE 1 outcome in adults but not in children ( P < .0001), while the type of surgery significantly influenced Engel I/ILAE 1 outcome in children but not in adults.ConclusionThe proportion of seizure freedom after TLE surgery was higher in children, although not significantly. Histopathology and the surgical approach can influence seizure outcome, with age-related variability.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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