Marton Toth1, Kata Szilvia Papp2, Noemi Gede3, Kornelia Farkas4, Sandor Kovacs5, Jean Isnard6, Koichi Hagiwara7, Csilla Gyimesi8, Diana Kuperczko8, Tamas Doczi9, Jozsef Janszky10. 1. Department of Neurology, Medical School, University of Pécs. Hungary, Pécs, Rét u. 2., H-7623, Hungary. Electronic address: toth.marton@pte.hu. 2. Department of Obstetrics and Gynaecology, Medical School, University of Pécs. Hungary, Pécs, Édesanyák útja 17., H-7624, Hungary. 3. Institute for Translational Medicine, Medical School, University of Pécs. Hungary, Pécs, Szigeti u. 12., H-7623, Hungary. 4. Institute for Bioanalysis, Medical School, University of Pécs. Hungary, Pécs, Szigeti u. 12., H-7623, Hungary. 5. Department of Health and Economy, Medical School, University of Pécs. Hungary, Pécs, Rákóczi út 2., H-7623, Hungary. 6. Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, 59 Boulevard Pinel, 69500, Lyon, France. 7. Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Hospital for Neurology and Neurosurgery Pierre Wertheimer, 59 Boulevard Pinel, 69500, Lyon, France; Central Integration of Pain (NeuroPain) Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France. 8. Department of Neurology, Medical School, University of Pécs. Hungary, Pécs, Rét u. 2., H-7623, Hungary. 9. Department of Neurosurgery, Medical School, University of Pécs, Pécs, Rét u. 2., H-7623, Hungary; MTA-PTE Clinical Neuroscience MRI Research Group, Pécs, Ifjúság u. 20, H-7624, Hungary. 10. Department of Neurology, Medical School, University of Pécs. Hungary, Pécs, Rét u. 2., H-7623, Hungary; MTA-PTE Clinical Neuroscience MRI Research Group, Pécs, Ifjúság u. 20, H-7624, Hungary.
Abstract
PURPOSE: Resective epilepsy surgery based on an invasive EEG-monitors performed with subdural grids (SDG) or depth electrodes (stereo-electroencephalography, SEEG) is considered to be the best option towards achieving seizure-free state in drug-resistant epilepsy. The authors present a meta-analysis, due to the lack of such a study focusing on surgical outcomes originating from SDG- or SEEG-monitors. METHOD: English-language studies published until May 2018, highlighting surgical outcomes were reviewed. Outcome measures including total number of SDG- or SEEG-monitors and resective surgeries; consecutively followed surgical cases; surgical outcomes classified by Engel in overall, temporal/extratemporal and lesional/nonlesional subgroups were analyzed. RESULTS: 19 articles containing 1025 SDG-interventions and 16 publications comprising 974 SEEG-monitors were researched. The rate of resective surgery deriving from SDG-monitoring hovered at 88.8% (95%CI:83.3-92.6%) (I2 = 77.0%;p < 0.001); in SEEG-group, 79.0% (95%CI:70.4-85.7%) (I2 = 72.5%;p < 0.001) was measured. After SDG-interventions, percentage of post-resective follow-up escalated to 96.0% (95%CI:92.0-98.1%) (I2 = 49.1%;p = 0.010), and in SEEG-group, it reached 94.9% (95%CI:89.3-97.6%) (I2 = 80.2%;p < 0.001). In SDG-group, ratio of seizure-free outcomes reached 55.9% (95%CI:50.9-60.8%) (I2 = 54.47%;p = 0.002). Using SEEG-monitor, seizure-freedom occurred in 64.7% (95%CI:59.2-69.8%) (I2 = 11.9%;p = 0.32). Assessing lesional cases, likelihood of Engel I outcome was found in 57.3% (95%CI:48.7%-65.6%) (I2 = 69.9%;p < 0.001), using SDG; while in SEEG-group, it was 71.6% (95%CI:61.6%-79.9%) (I2 = 24.5%;p = 0.225). In temporal subgroup, ratio of seizure-freedom was found to be 56.7% (95%CI:51.5%-61.9%) (I2 = 3.2%;p = 0.412) in SDG-group; whereas, SEEG-group reached 73.9% (95%CI:64.4%-81.6%); (I2 = 0.00%;p = 0.45). Significant differences between seizure-free outcomes were found in overall (p = 0.02), lesional (p = 0.031), and also, temporal (p = 0.002) comparisons. CONCLUSIONS: SEEG-interventions were associated, at least, non-inferiorly, with seizure-freedom compared with SDG-monitors in temporal, lesional and overall subgroups.
PURPOSE: Resective epilepsy surgery based on an invasive EEG-monitors performed with subdural grids (SDG) or depth electrodes (stereo-electroencephalography, SEEG) is considered to be the best option towards achieving seizure-free state in drug-resistant epilepsy. The authors present a meta-analysis, due to the lack of such a study focusing on surgical outcomes originating from SDG- or SEEG-monitors. METHOD: English-language studies published until May 2018, highlighting surgical outcomes were reviewed. Outcome measures including total number of SDG- or SEEG-monitors and resective surgeries; consecutively followed surgical cases; surgical outcomes classified by Engel in overall, temporal/extratemporal and lesional/nonlesional subgroups were analyzed. RESULTS: 19 articles containing 1025 SDG-interventions and 16 publications comprising 974 SEEG-monitors were researched. The rate of resective surgery deriving from SDG-monitoring hovered at 88.8% (95%CI:83.3-92.6%) (I2 = 77.0%;p < 0.001); in SEEG-group, 79.0% (95%CI:70.4-85.7%) (I2 = 72.5%;p < 0.001) was measured. After SDG-interventions, percentage of post-resective follow-up escalated to 96.0% (95%CI:92.0-98.1%) (I2 = 49.1%;p = 0.010), and in SEEG-group, it reached 94.9% (95%CI:89.3-97.6%) (I2 = 80.2%;p < 0.001). In SDG-group, ratio of seizure-free outcomes reached 55.9% (95%CI:50.9-60.8%) (I2 = 54.47%;p = 0.002). Using SEEG-monitor, seizure-freedom occurred in 64.7% (95%CI:59.2-69.8%) (I2 = 11.9%;p = 0.32). Assessing lesional cases, likelihood of Engel I outcome was found in 57.3% (95%CI:48.7%-65.6%) (I2 = 69.9%;p < 0.001), using SDG; while in SEEG-group, it was 71.6% (95%CI:61.6%-79.9%) (I2 = 24.5%;p = 0.225). In temporal subgroup, ratio of seizure-freedom was found to be 56.7% (95%CI:51.5%-61.9%) (I2 = 3.2%;p = 0.412) in SDG-group; whereas, SEEG-group reached 73.9% (95%CI:64.4%-81.6%); (I2 = 0.00%;p = 0.45). Significant differences between seizure-free outcomes were found in overall (p = 0.02), lesional (p = 0.031), and also, temporal (p = 0.002) comparisons. CONCLUSIONS: SEEG-interventions were associated, at least, non-inferiorly, with seizure-freedom compared with SDG-monitors in temporal, lesional and overall subgroups.
Authors: Adithya Sivaraju; Lawrence Hirsch; Nicolas Gaspard; Pue Farooque; Jason Gerrard; Yunshan Xu; Yanhong Deng; Eyiyemisi Damisah; Hal Blumenfeld; Dennis D Spencer Journal: Neurology Date: 2022-05-04 Impact factor: 11.800
Authors: Elisaveta Sokolov; Nathaniel D Sisterson; Helweh Hussein; Cheryl Plummer; Danielle Corson; Arun R Antony; Joseph M Mettenburg; Gena R Ghearing; Jullie W Pan; Alexandra Urban; Anto Bagić; R Mark Richardson; Vasileios Kokkinos Journal: Epilepsia Open Date: 2021-11-16