Long‐term seizure outcome of surgery versus no surgery for drug‐resistant partial epilepsy: A review of controlled studies

Abstract

SUMMARYA majority of patients with formerly drug-resistant temporal lobe epilepsy become seizure-free after surgery. However, apart from one 12-month randomized trial, it is unclear how many become seizure-free because of surgery. To determine the net benefit of surgery, we performed a systematic review and meta-analysis of the published evidence of how many patients in similar studies become seizure-free without surgery. Of 155 potentially eligible articles reviewed in full text, 29 (19%) fulfilled eligibility criteria. After excluding 9 publications, 20 studies form the base of evidence. Overall, 719 of 1,621 (44%) of patients with mostly temporal lobe surgery were seizure-free compared to 139 of 1113 (12%) of nonoperated controls [pooled random effects relative risk (RR) 4.26, 95% confidence interval (CI) 3.03-5.98]. The pooled risk difference in favor of surgery was 42% (95% CI 32-51%). We found no comparative outcome data in patients with extratemporal lobe epilepsy only. The available evidence from mostly nonrandomized observational studies indicates that in appropriately selected patients with drugresistant temporal lobe epilepsy, the combination of surgery with medical treatment is 4 times as likely as medical treatment alone to achieve freedom from seizures.

Surgical management of epilepsy

“…15 A meta-analysis of one RCT and 19 observational studies comparing surgery with medical therapy found an absolute risk reduction of 42% (95% CI 32%-51%) for any seizure recurrence in patients who underwent surgery. 27 Similar surgical outcomes have been reported in cohort studies involving older patients. 28 A recent observational study involving children under three years of age found that 48% were seizure-free after surgery and that seizures decreased by more than 75% in an additional 38% of patients.…”

18FDG‐PET in different subtypes of temporal lobe epilepsy: SEEG validation and predictive value

“…Concerning the surgical results, 33% of failure for TLE is globally in the range of surgical results after 2 years. 30 Failures are more numerous in "plus" and bilateral TLE subtypes.…”

Historical Risk Factors Associated with Seizure Outcome After Surgery for Drug-Resistant Mesial Temporal Lobe Epilepsy

“…The potential efficacy of resective surgery in patients with TLE uncontrolled by anti-epileptic drugs is undisputed [27][28][29] . However, it is critical to distinguish among different types and etiologies of TLE when predicting seizure outcome after surgery.…”