Predictors of seizure outcomes in children with tuberous sclerosis complex and intractable epilepsy undergoing resective epilepsy surgery: an individual participant data meta-analysis

To perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective epilepsy surgery. Electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), a...

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Bibliographic Details
Published in:PloS one 2013-02, Vol.8 (2), p.e53565-e53565
Main Authors: Fallah, Aria, Guyatt, Gordon H, Snead, 3rd, O Carter, Ebrahim, Shanil, Ibrahim, George M, Mansouri, Alireza, Reddy, Deven, Walter, Stephen D, Kulkarni, Abhaya V, Bhandari, Mohit, Banfield, Laura, Bhatnagar, Neera, Liang, Shuli, Teutonico, Federica, Liao, Jianxiang, Rutka, James T
Format: Article
Language:English
Subjects:
Adolescent
Adult
Archives
Archives & records
Bias
Bone surgery
Case-Control Studies
Child
Child, Preschool
Children
Cohort Studies
Convulsions & seizures
Data processing
EEG
Electroencephalography
Electroencephalography - methods
Epidemiology
Epilepsy
Epilepsy - surgery
Follow-Up Studies
Health sciences
Hospitals
Humans
Infant
Infant, Newborn
Magnetic resonance
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Medicine
Meetings
Meta-analysis
Middle Aged
Neurology
Neurosurgery
Patient outcomes
Patients
Quality assessment
Quality control
Regression analysis
Retrospective Studies
Risk analysis
Risk factors
Seizing
Seizures
Seizures (Medicine)
Seizures - surgery
Studies
Surgery
Surgical outcomes
Systematic review
Tomography
Treatment Outcome
Tuberous sclerosis
Tuberous Sclerosis - surgery
Young Adult
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Summary:To perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective epilepsy surgery. Electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions. We included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate. We resolved disagreements through discussion. One author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes. To identify predictors of a good seizure outcome (i.e. Engel Class I or II) we used logistic regression adjusting for length of follow-up for each preoperative variable. Of 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69%) participants (Engel Class I: 102(56%); Engel class II: 24(13%)). In univariable analyses, absence of generalized seizure semiology (OR = 3.1, 95%CI = 1.2-8.2, p = 0.022), no or mild developmental delay (OR = 7.3, 95%CI = 2.1-24.7, p = 0.001), unifocal ictal scalp electroencephalographic (EEG) abnormality (OR = 3.2, 95%CI = 1.4-7.6, p = 0.008) and EEG/Magnetic resonance imaging concordance (OR = 4.9, 95%CI = 1.8-13.5, p = 0.002) were associated with a good postoperative seizure outcome. Small retrospective cohort studies are inherently prone to bias, some of which are overcome using individual participant data. The best available evidence suggests four preoperative factors predictive of good seizure outcomes following resective epilepsy surgery. Large long-term prospective multicenter observational studies are required to further evaluate the risk factors identified in this review.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0053565