Systematic review and network meta-analysis of resective surgery for mesial temporal lobe epilepsy

Jain, Puneet; Tomlinson, George; Snead, Carter; Sander, Beate; Widjaja, Elysa

doi:10.1136/jnnp-2017-317783

Cited by 51 publications

(32 citation statements)

References 66 publications

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“…The probability of being seizure-free at 1-year following surgery [0.652 (95% CI: 0.567–0.728)] was based on the study by Jain et al . [20]. We used the study by Choi et al .…”

Section: Methodsmentioning

confidence: 99%

Early economic evaluation of MRI-guided laser interstitial thermal therapy (MRgLITT) and epilepsy surgery for mesial temporal lobe epilepsy

et al. 2019

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BackgroundMRI-guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive treatment for temporal lobe epilepsy (TLE), with limited effectiveness data. It is unknown if the cost savings associated with shorter hospitalization could offset the high equipment cost of MRgLITT. We examined the cost-utility of MRgLITT versus surgery for TLE from healthcare payer perspective, and the value of additional research to inform policy decision on MRgLITT.MethodsWe developed a microsimulation model to evaluate quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER) of MRgLITT versus surgery in TLE, assuming life-time horizon and 1.5% discount rate. Model inputs were derived from the literature. We conducted threshold and sensitivity analyses to examine parameter uncertainties, and expected value of partial perfect information analyses to evaluate the expected monetary benefit of eliminating uncertainty on probabilities associated with MRgLITT.ResultsMRgLITT yielded 0.08 more QALYs and cost $7,821 higher than surgery, with ICER of $94,350/QALY. Influential parameters that could change model outcomes include probabilities of becoming seizure-free from disabling seizures state and returning to disabling seizures from seizure-free state 5 years after surgery and MRgLITT, cost of MRgLITT disposable equipment, and utilities of disabling seizures and seizure-free states of surgery and MRgLITT. The cost-effectiveness acceptability curve showed surgery was preferred in more than 50% of iterations. The expected monetary benefit of eliminating uncertainty for probabilities associated with MRgLITT was higher than for utilities associated with MRgLITT.ConclusionsMRgLITT resulted in more QALYs gained and higher costs compared to surgery in the base-case. The model was sensitive to variations in the cost of MRgLITT disposable equipment. There is value in conducting more research to reduce uncertainty on the probabilities and utilities of MRgLITT, but priority should be given to research focusing on improving the precision of estimates on effectiveness of MRgLITT.

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“…The probability of being seizure-free at 1-year following surgery [0.652 (95% CI: 0.567–0.728)] was based on the study by Jain et al . [20]. We used the study by Choi et al .…”

Section: Methodsmentioning

confidence: 99%

Early economic evaluation of MRI-guided laser interstitial thermal therapy (MRgLITT) and epilepsy surgery for mesial temporal lobe epilepsy

et al. 2019

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“…More recent adaptations include (i) the modified Engel classification, which assesses postoperative seizure outcomes annually and in seizures days instead of an absolute seizure number to allow better comparison between individual patients, different centers and AEDs [12] and (ii) the ILAE classification, where the terminology was re-defined and seizures were classified based on their onset, specification of motor symptoms and non-motor symptoms [13]. Seizure outcomes for ATL and SAH were reported equivalent, regardless of surgery or approach [14]: A 71% seizure-freedom rate after >10 year follow-up was shown with the transsylvian approach [15]; similar rates were described for the transcortical and subtemporal approaches [16][17][18]. This notion has however been recently challenged by several meta-analyses favoring higher seizure freedom with ATL, although rates of seizure freedom were only subtlety different [19,20].…”

Section: Traditional Surgical Treatment Options In Pharmacoresistant mentioning

confidence: 99%

Laser thermal therapy for epilepsy surgery: current standing and future perspectives

Zemmar

Nelson

2020

International Journal of Hyperthermia

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More than 130-year ago, Sir Victor Horsley delivered a landmark address to the British Medical Association, in which he described successful localization and resection of an epileptogenic focus resulting in seizure freedom for the patient. Several important steps in epilepsy surgery have been achieved since, including resection techniques such as anterior temporal lobectomy and selective amygdalohippocampectomy, both resulting in 70-80% seizure freedom and distinct differences in neuropsychological outcomes. The most recent addition to techniques for epilepsy surgery is minimally invasive thermal therapy. Significant advances in imaging technology and thermal ablation have opened a novel avenue for epilepsy treatment, permitting surgical intervention with seizure-freedom rates approaching the success of traditional methods but with reduced invasiveness, blood loss and duration of postoperative hospital stay. Here, we review recent advances on stereotactic ablation techniques focused on epilepsy surgery. Finally, we present emerging navigation techniques, which allow a higher degree of freedom. The described technologies render precise navigation of the ablation probe to avoid critical structures along the trajectory path and open novel pathways to further minimize invasiveness and improve safety and efficacy. Improve safety and efficacy.

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“…Standardized anterior temporal lobectomy in patients with temporal lobe epilepsy involves removing 4-6 cm of the anterior temporal lobe, including the amygdala and hippocampus. Selective amygdalohippocampectomy preserves the temporal neocortex and underlying white matter and offers the theoretical advantage of lower cognitive decline following surgery 48) . Both approaches showed 50-70% similar seizure-free rate, 48-100% post-operative risk of permanent visual field defects, and 30-60% risk of verbal and visual memory decline 49,50) .…”

Section: Resective Surgerymentioning

confidence: 99%

Applications and Outcomes of Epilepsy Surgery in Pediatric Population

Yi¹,

Joon-Won²

2018

journalofthekoreanchildneurologysociety

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Epilepsy is one of the world's most common neurologic disorders and epilepsy surgery is a major treatment option for intractable epilepsy in pediatric patients. Understanding the sequential steps of epilepsy surgery is important for the selection of appropriate candidate for surgery. Surgical methods in epilepsy surgery should be decided according to the results of the presurgical evaluation and they can be categorized into resective surgery and disconnective surgery. The implantation of neuromodulation is also a potential surgical approach. Here, we reviewed the current state of presurgical assessment for intractable epilepsy in pediatric patients, novel surgical procedures, and associated outcome data.

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Systematic review and network meta-analysis of resective surgery for mesial temporal lobe epilepsy

Abstract: Direct evidence, indirect evidence and NMA did not identify a difference in seizure-free outcome of ATL versus SAH.

Cited by 51 publications

References 66 publications

Early economic evaluation of MRI-guided laser interstitial thermal therapy (MRgLITT) and epilepsy surgery for mesial temporal lobe epilepsy

Early economic evaluation of MRI-guided laser interstitial thermal therapy (MRgLITT) and epilepsy surgery for mesial temporal lobe epilepsy

Laser thermal therapy for epilepsy surgery: current standing and future perspectives

Applications and Outcomes of Epilepsy Surgery in Pediatric Population

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