P30 A PRISMA systematic review and meta-analysis of open and novel ‘minimally invasive’ techniques for mesial temporal lobe epilepsy (MTLE)

Objectives

One third of patients with focal epilepsy fail to achieve seizure freedom despite best medical therapy. Surgery may provide seizure freedom if the epileptogenic zone can be safely remove. We compare the outcomes following open surgery, laser interstitial thermal therapy (LITT), radiofrequency ablation (RFA) and radiosurgery (RS).

Design

PRISMA systematic review and meta-analysis.

Subjects

MTLE

Methods

Structured searchs of PubMed, Embase and Cochrane databases. Random effects meta-analysis to calculate effects sizes and a pooled estimate of the probability of remaining seizure free at one year following intervention.

Results

From 1212 screened publications, 57 articles were included in the quantitative analysis. Open surgery included anterior temporal lobectomy as well as transcortical, subtemporal and transsylvian selective amygdalohippocampectomy. The probability of remaining seizure free at one year was 0.89 (95% CI 0.83–0.93) with open surgery based on Level 1 and 2 evidence. RS resulted in 0.88 (95% CI 0.84–0.90) probability and a single RCT revealed RS was less efficacious than open surgery. Follow up duration and study sizes were limited with LITT and RFA providing a probability of remaining seizure free at one year of 0.71 (95% CI 0.65–0.76) and 0.86 (95% CI 0.76–0.92) respectively.

Conclusions

There is no evidence supporting novel ‘minimally invasive’ approaches as being as efficacious as open surgery. Secondary outcome measures such as neuropsychological outcome and intervention morbidity are poorly reported.

Pallidal stimulation in Parkinson disease differentially modulates local and network β activity

β hypersynchrony within the basal ganglia-thalamocortical (BGTC) network has been suggested as a hallmark of Parkinson disease (PD) pathophysiology. Subthalamic nucleus (STN)-DBS has been shown to alter cortical-subcortical synchronization. It is unclear whether this is a generalizable phenomenon of therapeutic stimulation across targets.

OBJECTIVES

We aimed to evaluate whether DBS of the globus pallidus internus (GPi) results in cortical-subcortical desynchronization, despite the lack of monosynaptic connections between GPi and sensorimotor cortex.

APPROACH

We recorded local field potentials from the GPi and electrocorticographic signals from the ipsilateral sensorimotor cortex, off medications in nine PD patients, undergoing DBS implantation. We analyzed both local oscillatory power and functional connectivity (coherence and debiased weighted phase lag index (dWPLI)) with and without stimulation while subjects were resting with eyes open.

MAIN RESULTS

DBS significantly suppressed low β power within the GPi (-26.98%  ±  15.14%), p  <  0.05) without modulation of sensorimotor cortical β power (low or high). In contrast, stimulation suppressed pallidocortical high β coherence (-38.89%  ±  6.19%, p  =  0.02) and dWPLI (-61.40%  ±  8.75%, p  =  0.02). Changes in cortical-subcortical functional connectivity were spatially specific to the motor cortex.

SIGNIFICANCE

We highlight the role of DBS in desynchronizing network activity, particularly in the high β band. The current study of GPi-DBS suggests these network-level effects are not necessarily dependent and potentially may be independent of the hyperdirect pathway. Importantly, these results draw a sharp distinction between the potential significance of low β oscillations locally within the basal ganglia and high β oscillations across the BGTC motor circuit.

Abstract MP090: Sleep Duration Predict Incident Obesity in Childhood and Adolescence: Meta-analysis of Prospective Studies

Objectives: To assess the longitudinal evidence of a relationship between duration of sleep and both incidence of overweight and/or obesity and changes in body mass index in infants, children and adolescents.

Methods: We performed a systematic search of publications using MEDLINE (1966-2016), EMBASE (from 1980), Web of Science (from 1945), the Cochrane Library and manual searches without language restrictions. Studies were included if they were prospective, had a follow up >1 year, had measured duration of sleep at baseline and assessed either incident cases of overweight and/or obesity or changes in body mass index prospectively. Relative risks (RR), regression coefficients (beta) and 95% C.I. were extracted and pooled using a random effect model. Sensitivity analyses and meta-regressions were performed, heterogeneity and publication bias were also assessed.

Results: Overall, 41 studies provided 56 independent cohort samples, including 98,130 boys and girls aged 0-18 years (follow-up 1 to 27 years). Sleep duration was assessed by questionnaire, either to parents or to children, actigraphy or polysomnography. Body mass index (BMI) was measured in all participants. In the pooled analyses, short duration of sleep was associated with a greater risk of becoming overweight or obese (RR: 1.57; 95% CI 1.34, 1.85; p<10 -5 ; n=59,471). There was significant heterogeneity (I 2 =92%, p<0.001), accounted for by three studies (I 2 =3% after their removal) and evidence of publication bias (p=0.007). The effect size increased with age (infants 1.40 [1.19, 1.65]; early childhood 1.53 [1.33, 1.76]; middle childhood 2.23 [2.18, 2.27]; adolescence 1.30 [1.11, 1.53]; p for heterogeneity <10 -5 ). The effect was not associated with average length of follow-up (p=0.923) or quality (p=0.475). BMI decreased for every hour of increased sleep (pooled beta: -0.01; -0.03, 0.00 kg/m 2 per h, p=0.032; n=16,225).

Conclusion: Short duration of sleep is a significant predictor of the development of overweight, obesity and weight gain from birth to adolescence.