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Child's Nervous System
Erschienen in: Child's Nervous System 5/2019

26.03.2019 | Original Article

Predictors of seizure recurrence in patients with surgery for focal cortical dysplasia: pairwise and network meta-analysis and trial sequential analysis

verfasst von: Jie Chen, Xin Chen, Chen Huang, He Zhu, Zhi Hou, Ning An, Shi-Yong Liu, Hui Yang, Chun-Qing Zhang

Erschienen in: Child's Nervous System | Ausgabe 5/2019

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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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Metadaten
Titel
Predictors of seizure recurrence in patients with surgery for focal cortical dysplasia: pairwise and network meta-analysis and trial sequential analysis
verfasst von
Jie Chen
Xin Chen
Chen Huang
He Zhu
Zhi Hou
Ning An
Shi-Yong Liu
Hui Yang
Chun-Qing Zhang
Publikationsdatum
26.03.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Child's Nervous System / Ausgabe 5/2019
Print ISSN: 0256-7040
Elektronische ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-019-04124-0

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