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Meta-Analysis
. 2013;8(2):e53565.
doi: 10.1371/journal.pone.0053565. Epub 2013 Feb 6.

Predictors of seizure outcomes in children with tuberous sclerosis complex and intractable epilepsy undergoing resective epilepsy surgery: an individual participant data meta-analysis

Aria Fallah  1 , Gordon H Guyatt, O Carter Snead 3rd, Shanil Ebrahim, George M Ibrahim, Alireza Mansouri, Deven Reddy, Stephen D Walter, Abhaya V Kulkarni, Mohit Bhandari, Laura Banfield, Neera Bhatnagar, Shuli Liang, Federica Teutonico, Jianxiang Liao, James T Rutka
Affiliations
Meta-Analysis

Predictors of seizure outcomes in children with tuberous sclerosis complex and intractable epilepsy undergoing resective epilepsy surgery: an individual participant data meta-analysis

Aria Fallah et al. PLoS One. 2013.

Abstract

Objective: To perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective epilepsy surgery.

Data sources: Electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions.

Study selection: We included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate. We resolved disagreements through discussion.

Data extraction: One author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes.

Data synthesis: To identify predictors of a good seizure outcome (i.e. Engel Class I or II) we used logistic regression adjusting for length of follow-up for each preoperative variable.

Results: Of 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69%) participants (Engel Class I: 102(56%); Engel class II: 24(13%)). In univariable analyses, absence of generalized seizure semiology (OR = 3.1, 95%CI = 1.2-8.2, p = 0.022), no or mild developmental delay (OR = 7.3, 95%CI = 2.1-24.7, p = 0.001), unifocal ictal scalp electroencephalographic (EEG) abnormality (OR = 3.2, 95%CI = 1.4-7.6, p = 0.008) and EEG/Magnetic resonance imaging concordance (OR = 4.9, 95%CI = 1.8-13.5, p = 0.002) were associated with a good postoperative seizure outcome.

Conclusions: Small retrospective cohort studies are inherently prone to bias, some of which are overcome using individual participant data. The best available evidence suggests four preoperative factors predictive of good seizure outcomes following resective epilepsy surgery. Large long-term prospective multicenter observational studies are required to further evaluate the risk factors identified in this review.

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Conflict of interest statement

Competing Interests: Dr. Bhandari receives research funding from Smith and Nephew, Stryker, DePuy, Amgen and Moximed. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. All other authors report no disclosures.

Figures

Figure 1
Figure 1. PRISMA 2009 Flow Diagram.
Figure 2
Figure 2. Number and percentage by Engel Classification of participants with TSC undergoing resective epilepsy surgery.
See this image and copyright information in PMC

References

    1. Wiederholt WC, Gomez MR, Kurland LT (1985) Incidence and prevalence of tuberous sclerosis in Rochester, Minnesota, 1950 through 1982. Neurology 35: 600–603. - PubMed
    1. Curatolo P, Bombardieri R, Jozwiak S (2008) Tuberous sclerosis. Lancet 372: 657–668. - PubMed
    1. Chu-Shore CJ, Major P, Camposano S, Muzykewicz D, Thiele EA (2010) The natural history of epilepsy in tuberous sclerosis complex. Epilepsia 51: 1236–1241. - PMC - PubMed
    1. Jansen FE, van Huffelen AC, Algra A, van Nieuwenhuizen O (2007) Epilepsy surgery in tuberous sclerosis: a systematic review. Epilepsia 48: 1477–1484. - PubMed
    1. Spencer S, Huh L (2008) Outcomes of epilepsy surgery in adults and children. Lancet Neurol 7: 525–537. - PubMed