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Meta-Analysis
. 2018 Feb 19;20(3):324-331.
doi: 10.1093/neuonc/nox130.

Clinical characteristics associated with postoperative seizure control in adult low-grade gliomas: a systematic review and meta-analysis

Xia Shan  1 , Xing Fan  1 , Xing Liu  1 , Zheng Zhao  1 , Yinyan Wang  2 , Tao Jiang  1   2   3
Affiliations
Meta-Analysis

Clinical characteristics associated with postoperative seizure control in adult low-grade gliomas: a systematic review and meta-analysis

Xia Shan et al. Neuro Oncol. .

Abstract

Background: Epilepsy is the most common symptom in patients with supratentorial low-grade gliomas (LGGs), which adversely affects the patient's quality of life. Poor seizure control with anti-epileptic therapy is an indication for surgery in these patients. Recent studies have sought to identify predictors of postoperative seizure control after surgical resection of LGG; gross total resection was shown to be a significant predictor in this respect. However, the prognostic value of other factors is not clear.

Methods: We performed a systematic review and meta-analysis of 23 studies with a combined study population of 2641 patients with LGG, in order to identify potential factors associated with favorable postoperative seizure control. Data were extracted on age and sex of patient, tumor location, tumor histology, type of seizure, seizure duration, extent of resection, and imaging characteristics.

Results: Patients ≥45 years of age achieved better postoperative seizure control (risk ratio [RR], 0.89; 95% CI, 0.81-0.99). Focal seizures were associated with poor seizure control (RR, 1.32; 95% CI, 1.18-1.49) compared with generalized seizures (RR, 0.77; 95% CI, 0.68-0.87). Prolonged history of seizures (≥1 y) had a negative impact on postoperative seizure control (RR, 1.22; 95% CI, 1.10-1.34). Gross total resection was superior to subtotal resection with respect to postoperative seizure control (RR, 0.68; 95% CI, 0.63-0.73).

Conclusions: This systematic review and meta-analysis identified predictors of postoperative seizure control in patients undergoing surgical resection of LGGs. Our results provide a reference for clinical treatment of LGG-related epilepsy.

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Figures

Fig. 1
Fig. 1
Flow diagram of the literature search and the selection of articles.
Fig. 2
Fig. 2
Forest plot of risk ratios for age ≥45 years vs age <45 years. Patients aged ≥45 years had better seizure control compared with those aged <45 years (RR, 0.89; 95% CI, 0.81–0.99; P = 0.02).
Fig. 3
Fig. 3
Forest plots of risk ratios for (A) focal seizure vs nonfocal seizure and (B) generalized seizure vs nongeneralized seizure calculated from individual studies. No significant difference is found in postoperative outcomes between patients with focal seizure and those with nonfocal seizure (RR, 1.32; 95% CI, 1.18–1.49; P < 0.001; NNT, 6), while patients with generalized seizures showed significantly better seizure control (RR, 0.77; 95% CI, 0.68–0.87; P < 0.001; NNT, 6).
Fig. 4
Fig. 4
Forest plot of risk ratios for EOR calculated from individual studies. Gross total resection significantly reduced the risk of postoperative seizures compared with subtotal resection (RR, 1.47; 95% CI, 1.37–1.58; P < 0.001; NNT, 4).
See this image and copyright information in PMC

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