Systematic review and meta-analysis of standard vs selective temporal lobe epilepsy surgery

Josephson, Colin B.; Dykeman, Jonathan; Fiest, Kirsten M.; Liu, Xiaorong; Sadler, R. Mark; Jetté, Nathalie; Wiebe, Samuel

doi:10.1212/wnl.0b013e3182904f82

Cited by 269 publications

(182 citation statements)

References 31 publications

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“…In a meta‐analysis, anterior temporal lobectomy had an 8% greater seizure freedom rate than transcortical selective amygdalohippocampectomy 61. Amygdalohippocampectomy was associated with better postoperative memory than temporal pole and hippocampal resection 62…”

Section: Scope Of Surgical Treatmentmentioning

confidence: 99%

Getting the best outcomes from epilepsy surgery

Vakharia

Duncan

Witt

et al. 2018

Annals of Neurology

192

139

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Neurosurgery is an underutilized treatment that can potentially cure drug‐refractory epilepsy. Careful, multidisciplinary presurgical evaluation is vital for selecting patients and to ensure optimal outcomes. Advances in neuroimaging have improved diagnosis and guided surgical intervention. Invasive electroencephalography allows the evaluation of complex patients who would otherwise not be candidates for neurosurgery. We review the current state of the assessment and selection of patients and consider established and novel surgical procedures and associated outcome data. We aim to dispel myths that may inhibit physicians from referring and patients from considering neurosurgical intervention for drug‐refractory focal epilepsies. Ann Neurol 2018;83:676–690

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Section: Scope Of Surgical Treatmentmentioning

confidence: 99%

Getting the best outcomes from epilepsy surgery

Vakharia

Duncan

Witt

et al. 2018

Annals of Neurology

192

139

View full text Add to dashboard Cite

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“…Nonetheless, three studies have found better seizure-control in patients submitted to ATL 4,22,23 . Similarly, two recent systematic reviews concluded that ATL is associated with a reduced rate of seizure recurrence compared to SelAH 24,25 . In other words, a consensus on this matter has not yet been reached.…”

Section: Discussionmentioning

confidence: 92%

Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

Nascimento

Gatto

Silvado

et al. 2015

Arq. Neuro-Psiquiatr.

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Objective To contribute our experience with surgical treatment of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH). Method This is a retrospective observational study. The sample included patients with medically refractory mTLE due to unilateral mesial temporal sclerosis who underwent either ATL or SelAH, at Hospital de Clinicas – UFPR, from 2005 to 2012. We report seizure outcomes, using Engel classification, cognitive outcomes, using measurements of verbal and visuospatial memories, as well as operative complications. Result Sixty-seven patients (33 ATL, 34 SelAH) were studied; median follow-up was 64 months. There was no statistically significant difference in seizure or neuropsychological outcomes, although verbal memory was more negatively affected in ATL operations on patients’ dominant hemispheres. Higher number of major complications was observed in the ATL group (p = 0.004). Conclusion Seizure and neuropsychological outcomes did not differ. ATL appeared to be associated with higher risk of complications.

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“…A recent survey of nine major epilepsy surgery centers22 shows that this challenging population of DRE patients with normal MRI currently represents the main patient population presenting for consideration of surgery, and that the proportion of invasive EEG recordings not followed by resections has more than tripled between 1991 and 2011. In an era in which multiple types of invasive EEG are available, including stereo‐EEG, subdural electrodes, and combinations of subdural electrodes and depths, we should rigorously define criteria for choosing which technology to use and when the risk/benefit ratio of such evaluations, especially when invasive, is justified.Selective amygdalohippocampectomy versus traditional temporal lobe resections, particularly in patients with preserved memory function: Limiting the resection of the temporal stem and mesial structures is speculated to optimize neuropsychological outcomes, whereas including these structures in a standard temporal lobe resection is hypothesized by some to be necessary for optimal seizure outcomes 66, 67

Ablative versus resective strategies for temporal and extratemporal epilepsy also need further investigation.

The indications and comparative effectiveness of the different neuromodulatory approaches should be defined.

…”

Section: Gaps In Knowledgementioning

confidence: 99%

“…Selective amygdalohippocampectomy versus traditional temporal lobe resections, particularly in patients with preserved memory function: Limiting the resection of the temporal stem and mesial structures is speculated to optimize neuropsychological outcomes, whereas including these structures in a standard temporal lobe resection is hypothesized by some to be necessary for optimal seizure outcomes 66, 67…”

Section: Gaps In Knowledgementioning

confidence: 99%

Not all that glitters is gold: A guide to surgical trials in epilepsy

Jehi

2016

Epilepsia Open

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SummaryEpilepsy surgery is often the only effective treatment in appropriately selected patients with drug‐resistant epilepsy, a disease affecting about 30% of those with epilepsy. We review the evidence supporting the use of epilepsy surgery, with a focus on randomized controlled trials (RCTs). Second, we identify gaps in knowledge about the benefits of epilepsy surgery for certain populations, the challenges of individualizing the choice of surgery, and our lack of understanding of the mechanisms of surgical outcomes. We conducted a search (MEDLINE, Embase, Cochrane, Clinicaltrials.gov) on March 2, 2016, to identify epilepsy surgery RCTs, systematic reviews, or health technology assessments (HTAs). Abstracts were screened to identify resective, palliative (e.g., corpus callosotomy, multiple subpial transection [MST]), ablative (e.g., Laser interstitial thermal therapy [LITT], gamma knife radiosurgery [RS]), and neuromodulation (e.g., cerebellar stimulation [CS], hippocampal stimulation [HS], repetitive transcranial magnetic stimulation [rTMS], responsive neurostimulation [RNS], thalamic stimulation [TS], trigeminal nerve stimulation [TNS], and vagal nerve stimulation [VNS]) RCTs. Study characteristics and outcomes were extracted. Knowledge gaps were identified. Of 1,205 abstracts, 20 RCTs were identified (resective surgery including corpus callosotomy [n = 7], MST [n = 0], RS [n = 1, 3 papers], LITT [n = 0], CS [n = 1], HS [n = 2], RNS [n = 1], rTMS [n = 1], TNS [n = 1], TS [n = 1], and VNS [n = 5]). Most studies targeted patients with temporal lobe epilepsy (TLE) and none examined the effectiveness of resective surgical therapies in patients with extra‐TLE (ETLE) or with specific lesions aside from mesial temporal lobe sclerosis. No pediatric surgical RCTs were identified except for VNS. Few RCTs address the effectiveness of surgery in epilepsy and most are of limited generalizability. Future studies are needed to compare the effectiveness of different surgical strategies, better understand the mechanisms of surgical outcomes, and define the ideal surgical approaches, particularly for patients with high or very low cognitive function, normal imaging, or ETLE.

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Systematic review and meta-analysis of standard vs selective temporal lobe epilepsy surgery

Abstract: Standard ATL confers an improved chance of achieving freedom from disabling seizures in patients with TLE. Improved seizure freedom must be balanced against the neuropsychological impact of each procedure. A randomized controlled trial is justified.

Cited by 269 publications

References 31 publications

Getting the best outcomes from epilepsy surgery

Getting the best outcomes from epilepsy surgery

Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy

Not all that glitters is gold: A guide to surgical trials in epilepsy

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