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Chen J, Chen X, Huang C, Zhu H, Hou Z, An N, Liu SY, Yang H, Zhang CQ. Predictors of seizure recurrence in patients with surgery for focal cortical dysplasia: pairwise and network meta-analysis and trial sequential analysis. Childs Nerv Syst 2019; 35:753-767. [PMID: 30911833 DOI: 10.1007/s00381-019-04124-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/05/2019] [Indexed: 12/17/2022]
Abstract
OBJECT The aim of this study was to determine the predictors of seizure recurrence in surgery for focal cortical dysplasia (FCD) by conducting a meta-analysis. METHODS Publications that met the pre-stated inclusion criteria were selected from PubMed and CNKI databases. Two authors extracted data independently about prognostic factors, surgical outcome, and clinical characteristics of participants. A fixed-effects model was used to calculate the summary of odds ratio (OR) with 95% confidence interval (CI). RESULTS Forty-eight studies were included in our meta-analysis. Three predictors of seizure recurrence (Engel class III/IV)-histological FCD type I, incomplete resection, and extratemporal location were determined; combined OR with 95% CI were 1.94 (95%CI 1.53-2.46), 12.06 (95%CI 7.32-19.88), and 1.91 (95%CI 1.06-3.44), respectively. Trial sequential analysis revealed that the outcomes had a sufficient sample size to reach firm conclusions. Furthermore, seizure location was not substantially modified by geographic region, while histological FCD type I and incomplete resection showed a significant association with seizure recurrence in different continents except Asia for incomplete resection. Sensitivity analyses restricted to studies for each variable yielded robust results. Little evidence of publication bias was observed. Meanwhile, the difference in the standard for outcome failed to influence the results for prognosis. Network meta-analysis including 13 trials comparing subtypes of FCD found the FCD IIb had the lowest seizure recurrence rate. CONCLUSIONS This meta-analysis suggests that histological FCD type I, incomplete resection, and extratemporal location are recurrence factors in patients with epilepsy surgery for FCD. In addition, FCD IIb is associated with the highest rates of postoperative seizure control among the subtypes of FCD, type I and type II.
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Affiliation(s)
- Jie Chen
- Department of Neurosurgery, Chongqing University CancerHospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, China
| | - Xin Chen
- Department of Neurosurgery, General Hospital of the People's Liberation Army Chengdu Military Region, Chengdu, 610083, Sichuan, China
| | - Chen Huang
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, 77030, USA
| | - He Zhu
- Department of Internal Medicine St. Luke's Hospital, Chesterfield, MO, 63017, USA
| | - Zhi Hou
- Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Ning An
- Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Shi-Yong Liu
- Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Hui Yang
- Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Chun-Qing Zhang
- Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.
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Huang C, Zhang H, Chi XS, Chen N, Gong J, Zhou Q, Blümcke I, Zhou D, Li JM. Putting the new ILAE classification of focal cortical dysplasia into practice in western China. Seizure 2017; 51:133-138. [PMID: 28843774 DOI: 10.1016/j.seizure.2017.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To re-examine drug-resistant epilepsy cases using the revised 2011 ILAE classification of focal cortical dysplasia (FCD). METHODS Patients with drug-resistant epilepsy who have undergone epilepsy surgery in West China Hospital between July 2012 and Jun 2014 were included. Clinical histories, pathological diagnoses, and surgical outcomes were reviewed. A questionnaire was developed to investigate the clinical practice of the new classification. A short-term training program on FCD was carried out to improve pathological diagnosis accuracy. RESULTS 260 consecutive cases (177 male and 83 female) were included. Pathological diagnosis was changed in 70 cases (26.9%) after re-examination. The five most common pathological types were hippocampal sclerosis (19.2%, 50/260), brain tumors (17.7%, 46/260), vascular malformations (16.2%, 42/260), glial scars (11.2%, 29/260) and FCD (10.0%, 26/260). The most common subtype of isolated FCD was FCD IIb (53.8%, 14/26), followed by FCD IIa (42.3%, 11/26) and FCD Ib (3.8%, 1/26). In addition, forty-five cases were diagnosed as associated FCD type III (17.3%, 45/260). Half of patients with FCD achieved Engel class I at two-year follow-up. Questionnaire investigation suggested most participant pathologists lack sufficient knowledge on the new classification. The diagnostic sensitivity for different FCD subtypes was significantly improved by two to six folds after short-term training. CONCLUSIONS FCD is an important etiology of drug-resistant epilepsy in western China. It is essential to provide continuing trainings to improve diagnostic precision of FCD in developing countries.
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Affiliation(s)
- Cheng Huang
- Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China; Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Heng Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Sa Chi
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ni Chen
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041,Sichuan, People's Republic of China
| | - Jing Gong
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041,Sichuan, People's Republic of China
| | - Qiao Zhou
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, 610041,Sichuan, People's Republic of China
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jin-Mei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Son EI, Kim JE. Spectrum of neurosurgeon's role in epilepsy surgery. Biomed J 2016; 39:177-82. [PMID: 27621118 PMCID: PMC6140298 DOI: 10.1016/j.bj.2016.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/21/2016] [Indexed: 11/28/2022] Open
Abstract
It is well known that there is high quality evidence of epilepsy surgery as an effective and safe option for patients with drug refractory epilepsy by advanced imaging technology and computerized electrophysiological facilities during recent three decades. However, it still remains debate regarding necessities of epilepsy surgery in terms of less satisfactory surgical outcome, especially in non-lesional neocortical epilepsies. This review is for the role of epileptic neurosurgeon rather than the role of epilepsy surgery, namely, the necessity of neurosurgeon's positive participation starting from the first visit of epilepsy patients followed by pertaining process by stages and its degree of contribution. All experienced epilepsy centers also need innovative or challenging trial absolutely through this kind of standpoint, because all of the present protocols and techniques are coming from the past. In any event, the interdepartmental and interpersonal cooperation is inevitable especially for improving patient's quality of life. Serious neurosurgical considerations are needed for patients with intractable epilepsies, especially in referred cases from other center for the purpose of double check, and incongruent cases with contrary opinions by epileptologist.
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Affiliation(s)
- Eun-Ik Son
- Department of Neurosurgery and Epilepsy Center, Keimyung University Dongsan Medical Center, South Korea.
| | - Ji-Eun Kim
- Department of Neurology, School of Medicine, Catholic University of Daegu, South Korea
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