Jin-Tao Liu1, Bei Liu2, Hua Zhang3. 1. Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province,China; Department of Surgery, the 413th Hospital of the Chinese People's Liberation Army, Zhoushan 316000, China. 2. Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province,China. 3. Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province,China. Electronic address: zhanghua2016@sohu.com.
Abstract
OBJECTIVE: Surgery and drug therapy are the two main treatments for refractory epilepsy. However, to date, there has not been an adequate comparison of the outcomes of these two treatments. This systematic review compared the overall outcome of surgery and medical treatment in patients with drug-resistant epilepsy. METHODS: Articles published in Embase, Medline, Pubmed, and the Cochrane library were searched from their inception until June 2016. RESULTS: Twenty of the eighty-one (24.7%) full-text articles reviewed fulfilled the eligibility criteria and were included in the meta-analysis. Of 1800 patients with drug-resistant epilepsy, 526 of 923 patients (57.0%) in the surgery group were seizure-free compared with 134 of 877 patients (15.3%) in the medical treatment group (19 studies, risk ratio (RR)=3.72, 95% confidence interval (CI) [2.75-5.03]; P<0.00001, I2=53%). In addition, more patients were off antiepileptic drugs (AEDs) in the surgical group (3 studies, n=438, RR=4.76, 95% CI [2.21, 10.28], P<0.0001, I2=0%). Although different studies used different questionnaires to assess patient quality of life (QOL) in both treatment groups, the overall postintervention QOL scores were higher in the surgery than in the medical treatment group, by SMD (6 studies, n=459, SMD=0.61, 95% CI [0.23, 0.98], P=0.002, I2=66%). CONCLUSION: As the complications of interventions, declines in memory, and word recall/naming were not assessed in the meta-analysis, the conclusions are limited to seizure-free, AED use, and QOL. The current evidence indicate that compared with medical treatment, surgery is more likely to achieve seizure-free, off AEDs, and better QOL.
OBJECTIVE: Surgery and drug therapy are the two main treatments for refractory epilepsy. However, to date, there has not been an adequate comparison of the outcomes of these two treatments. This systematic review compared the overall outcome of surgery and medical treatment in patients with drug-resistant epilepsy. METHODS: Articles published in Embase, Medline, Pubmed, and the Cochrane library were searched from their inception until June 2016. RESULTS: Twenty of the eighty-one (24.7%) full-text articles reviewed fulfilled the eligibility criteria and were included in the meta-analysis. Of 1800 patients with drug-resistant epilepsy, 526 of 923 patients (57.0%) in the surgery group were seizure-free compared with 134 of 877 patients (15.3%) in the medical treatment group (19 studies, risk ratio (RR)=3.72, 95% confidence interval (CI) [2.75-5.03]; P<0.00001, I2=53%). In addition, more patients were off antiepileptic drugs (AEDs) in the surgical group (3 studies, n=438, RR=4.76, 95% CI [2.21, 10.28], P<0.0001, I2=0%). Although different studies used different questionnaires to assess patient quality of life (QOL) in both treatment groups, the overall postintervention QOL scores were higher in the surgery than in the medical treatment group, by SMD (6 studies, n=459, SMD=0.61, 95% CI [0.23, 0.98], P=0.002, I2=66%). CONCLUSION: As the complications of interventions, declines in memory, and word recall/naming were not assessed in the meta-analysis, the conclusions are limited to seizure-free, AED use, and QOL. The current evidence indicate that compared with medical treatment, surgery is more likely to achieve seizure-free, off AEDs, and better QOL.
Authors: A E Vaudano; L Mirandola; F Talami; G Giovannini; G Monti; P Riguzzi; L Volpi; R Michelucci; F Bisulli; E Pasini; P Tinuper; L Di Vito; G Gessaroli; M Malagoli; G Pavesi; F Cardinale; L Tassi; L Lemieux; S Meletti Journal: Brain Topogr Date: 2021-06-21 Impact factor: 3.020
Authors: Merran R Courtney; Ana Antonic-Baker; Benjamin Sinclair; John-Paul Nicolo; Andrew Neal; Meng Law; Patrick Kwan; Terence J O'Brien; Lucy Vivash Journal: BMJ Open Date: 2022-10-06 Impact factor: 3.006