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Cui TY, Wu H, Tang CY, Wang XF, Li TF, Zhou J. Surgical outcomes of patients with genetically refractory epilepsy: A systematic review and meta-analysis. Seizure 2024; 120:124-134. [PMID: 38959583 DOI: 10.1016/j.seizure.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE To summarize the surgical outcomes of genetically refractory epilepsy and identify prognostic factors for these outcomes. METHODS A literature search of the PubMed, Web of Science, and Embase databases for relevant studies, published between January 1, 2002 and December 31, 2023, was performed using specific search terms. All studies addressing surgical outcomes and follow-up of genetically refractory epilepsy were included. All statistical analyses were performed using STATA software (StataCorp LLC, College Station, TX, USA). This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2020 (i.e., "PRISMA") reporting guidelines. RESULTS Of the 3833 studies retrieved, 55 fulfilled the inclusion criteria. Eight studies were eligible for meta-analysis at the study level. Pooled outcomes revealed that 74 % of patients who underwent resective surgery (95 % confidence interval [CI] 0.55-0.89; z = 9.47, p < 0.05) achieved Engel I status at the last follow-up. In the study level analysis, pooled outcomes revealed that 9 % of patients who underwent vagus nerve stimulation achieved seizure-free status (95 % CI 0.00-0.31; z = 1.74, p < 0.05), and 61 % (95 % CI 0.55-0.89; z = 11.96, p < 0.05) achieved a 50 % reduction in seizure frequency at the last follow-up. Fifty-three studies comprising 249 patients were included in an individual-level analysis. Among patients who underwent lesion resection or lobectomy/multilobar resection, 65 % (100/153) achieved Engel I status at the last follow-up. Univariate analysis indicated that female sex, somatic mutations, and presenting with focal seizure symptoms were associated with better prognosis (p < 0.05). Additionally, 75 % (21/28) of patients who underwent hemispherectomy/hemispherotomy achieved Engel I status at the last follow-up. In the individual-level analysis, among patients treated with vagus nerve stimulation, 21 % (10/47) were seizure-free and 64 % (30/47) experienced >50 % reduction in seizure frequency compared with baseline. CONCLUSION Meticulous presurgical evaluation and selection of appropriate surgical procedures can, to a certain extent, effectively control seizures. Therefore, various surgical procedures should be considered when treating patients with genetically refractory epilepsy.
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Affiliation(s)
- Tian-Yi Cui
- Functional Neurosurgery Department, Sanbo Brain Hospital, Capital Medical University, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Han Wu
- Functional Neurosurgery Department, Sanbo Brain Hospital, Capital Medical University, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Chong-Yang Tang
- Functional Neurosurgery Department, Sanbo Brain Hospital, Capital Medical University, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Xiong-Fei Wang
- Functional Neurosurgery Department, Sanbo Brain Hospital, Capital Medical University, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Tian-Fu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Clinical Research on Epilepsy, Beijing, China; Centre of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Jian Zhou
- Functional Neurosurgery Department, Sanbo Brain Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Clinical Research on Epilepsy, Beijing, China; Centre of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
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Shen L, Wang M, Zhao J, Ruan Y, Yang J, Chai S, Dai X, Yang B, Cai Y, Zhou Y, Mei Z, Zheng Z, Xu D, Guo H, Lei Y, Cheng R, Yue C, Wang T, Zhao Y, Liu X, Chai Y, Chen J, Du H, Xiong N. Study on the relationship between obesity and complications of Pediatric Epilepsy surgery. BMC Pediatr 2023; 23:142. [PMID: 36997989 PMCID: PMC10061988 DOI: 10.1186/s12887-023-03948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/09/2023] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE Studies have shown that obesity has a significant impact on poor surgical outcomes. However, the relationship between obesity and pediatric epilepsy surgery has not been reported. This study aimed to explore the relationship between obesity and complications of pediatric epilepsy surgery and the effect of obesity on the outcome of pediatric epilepsy surgery, and to provide a reference for weight management of children with epilepsy. METHODS A single-center retrospective analysis of complications in children undergoing epilepsy surgery was conducted. Body mass index (BMI) percentiles were adjusted by age and used as a criterion for assessing obesity in children. According to the adjusted BMI value, the children were divided into the obese group (n = 16) and nonobese group (n = 20). The intraoperative blood loss, operation time, and postoperative fever were compared between the two groups. RESULTS A total of 36 children were included in the study, including 20 girls and 16 boys. The mean age of the children was 8.0 years old, ranging from 0.8 to 16.9 years old. The mean BMI was 18.1 kg/m2, ranging from 12.4 kg/m2 to 28.3 kg/m2. Sixteen of them were overweight or obese (44.4%). Obesity was associated with higher intraoperative blood loss in children with epilepsy (p = 0.04), and there was no correlation between obesity and operation time (p = 0.21). Obese children had a greater risk of postoperative fever (56.3%) than nonobese children (55.0%), but this was statistically nonsignificant (p = 0.61). The long-term follow-up outcomes showed that 23 patients (63.9%) were seizure-free (Engel grade I), 6 patients (16.7%) had Engel grade II, and 7 patients (19.4%) had Engel grade III. There was no difference in long-term seizure control outcomes between obese and nonobese groups (p = 0.682). There were no permanent neurological complications after surgery. CONCLUSION Compared with nonobese children with epilepsy, obese children with epilepsy had a higher intraoperative blood loss. It is necessary to conduct early weight management of children with epilepsy as long as possible.
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Affiliation(s)
- Lei Shen
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Mengyang Wang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Jingwei Zhao
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Yuanyuan Ruan
- Department of Neurosurgery, Wuhan Children's Hospital, 430010, Wuhan, Hubei, China
| | - Jingyi Yang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Songshan Chai
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Xuan Dai
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Bangkun Yang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Yuankun Cai
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Yixuan Zhou
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Zhimin Mei
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Zhixin Zheng
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Dongyuan Xu
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Hantao Guo
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Yu Lei
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Runqi Cheng
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Chuqiao Yue
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Tiansheng Wang
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Yunchang Zhao
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Xinyu Liu
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Yibo Chai
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Jingcao Chen
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China
| | - Hao Du
- Department of Neurosurgery, Wuhan Children's Hospital, 430010, Wuhan, Hubei, China.
| | - Nanxiang Xiong
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, 430071, Wuhan, Hubei, China.
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Sun Y, Chao S, Ouyang H, Zhang W, Luo W, Nie Q, Wang J, Luo C, Ni G, Zhang L, Yang J, Feng H, Mao G, Li Z. Hybrid nanogenerator based closed-loop self-powered low-level vagus nerve stimulation system for atrial fibrillation treatment. Sci Bull (Beijing) 2022; 67:1284-1294. [PMID: 36546158 DOI: 10.1016/j.scib.2022.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/23/2022] [Accepted: 03/28/2022] [Indexed: 01/07/2023]
Abstract
Atrial fibrillation is an "invisible killer" of human health. It often induces high-risk diseases, such as myocardial infarction, stroke, and heart failure. Fortunately, atrial fibrillation can be diagnosed and treated early. Low-level vagus nerve stimulation (LL-VNS) is a promising therapeutic method for atrial fibrillation. However, some fundamental challenges still need to be overcome in terms of flexibility, miniaturization, and long-term service of bioelectric stimulation devices. Here, we designed a closed-loop self-powered LL-VNS system that can monitor the patient's pulse wave status in real time and conduct stimulation impulses automatically during the development of atrial fibrillation. The implant is a hybrid nanogenerator (H-NG), which is flexible, light weight, and simple, even without electronic circuits, components, and batteries. The maximum output of the H-NG was 14.8 V and 17.8 μA (peak to peak). In the in vivo effect verification study, the atrial fibrillation duration significantly decreased by 90% after LL-VNS therapy, and myocardial fibrosis and atrial connexin levels were effectively improved. Notably, the anti-inflammatory effect triggered by mediating the NF-κB and AP-1 pathways in our therapeutic system is observed. Overall, this implantable bioelectronic device is expected to be used for self-powerability, intelligentization, portability for management, and therapy of chronic diseases.
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Affiliation(s)
- Yu Sun
- Department of Neurosurgery, General Hospital of Armed Police Forces, Anhui Medical University, Hefei 230032, China; Department of Neurosurgery, The Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Shengyu Chao
- Beijing Key Laboratory of Micro-nano Energy and Sensor, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China; School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Han Ouyang
- School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Weiyi Zhang
- Beijing Key Laboratory of Micro-nano Energy and Sensor, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China
| | - Weikang Luo
- Institute of Integrative Medicine, Department of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Qingbin Nie
- Department of Neurosurgery, The Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Jianing Wang
- Department of Neurosurgery, General Hospital of Armed Police Forces, Anhui Medical University, Hefei 230032, China; Department of Neurosurgery, The Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Changyi Luo
- Department of Neurosurgery, General Hospital of Armed Police Forces, Anhui Medical University, Hefei 230032, China; Department of Neurosurgery, The Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Gongang Ni
- Department of Neurosurgery, General Hospital of Armed Police Forces, Anhui Medical University, Hefei 230032, China; Department of Neurosurgery, The Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Lingyu Zhang
- Department of Neurosurgery, General Hospital of Armed Police Forces, Anhui Medical University, Hefei 230032, China; Department of Neurosurgery, The Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China.
| | - Hongqing Feng
- Beijing Key Laboratory of Micro-nano Energy and Sensor, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China; School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Gengsheng Mao
- Department of Neurosurgery, General Hospital of Armed Police Forces, Anhui Medical University, Hefei 230032, China; Department of Neurosurgery, The Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing 100039, China.
| | - Zhou Li
- Beijing Key Laboratory of Micro-nano Energy and Sensor, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 101400, China; School of Nanoscience and Technology, University of Chinese Academy of Sciences, Beijing 100049, China; School of Chemistry and Chemical Engineering, Center on Nanoenergy Research, Guangxi University, Nanning 530004, China; Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing 100101, China.
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Liu S, Xiong Z, Wang J, Tang C, Deng J, Zhang J, Guo M, Guan Y, Zhou J, Zhai F, Luan G, Li T. Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy. Ther Adv Chronic Dis 2022; 13:20406223211066738. [PMID: 35070253 PMCID: PMC8771757 DOI: 10.1177/20406223211066738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) is a therapeutic approach for patients with refractory postencephalitic epilepsy (PEE), which is characterized by drug resistance and disappointing surgical outcomes. However, the efficacy of VNS has not yet been studied in patients with refractory PEE. The present study aimed to demonstrate the efficacy of VNS and evaluate potential clinical predictors in patients with refractory PEE. METHODS We retrospectively collected the outcomes of VNS with at least a 1-year follow-up in all patients with refractory PEE. Subgroups were classified as responders and non-responders according to the efficacy of VNS (⩾50% or < 50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS responsiveness. RESULTS A total of 42 refractory PEE patients who underwent VNS therapy were enrolled, with an average age of 21.13 ± 9.70 years. Seizure frequency was reduced by more than 50% in 64.25% of patients, and 7.14% of patients achieved seizure-free events after VNS therapy. In addition, the response rates increased over time, with 40.5%, 50.0% and 57.1%, respectively at 6 months, 12 months, and 24 months after VNS therapy. Preoperative duration of epilepsy, monthly seizure frequency, and spatial distribution of interictal epileptic discharges (IEDs) were correlated with responders (p < 0.05) in the univariate analysis. Further multivariate regression analysis demonstrated that refractory PEE patients with high monthly seizure frequency or Focal IEDs (focal or multifocal epileptiform discharges) achieved better efficacy on VNS (p = 0.010, p = 0.003, respectively). CONCLUSION VNS is an effective palliative therapy for patients with refractory PEE. Focal IEDs (focal or multifocal epileptiform discharges) and high seizure frequency were potential preoperative predictors of effectiveness after VNS therapy.
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Affiliation(s)
- Siqi Liu
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Xiong
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chongyang Tang
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jiahui Deng
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyi Guo
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Yuguang Guan
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Feng Zhai
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Brain Institute, Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Epilepsy Research, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tianfu Li
- Department of Neurology, Center of Epilepsy, Beijing Institute for Brain Disorders, Sanbo Brain Hospital, Capital Medical University, XiangshanYikesong 50, Haidian District, Beijing 100093, China
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