Seizure outcome of pediatric epilepsy surgery: systematic review and meta-analyses

Objective: This systematic review and meta-analyses assessed seizure outcome following pediatric epilepsy surgery.

Methods: MEDLINE, Embase and Cochrane were searched for pediatric epilepsy surgery original research from 1990 to 2017. The outcome was seizure freedom at 12 months or longer follow-up. Using random effects models, the effect sizes for controlled studies, uncontrolled studies on surgery locations (temporal lobe [TL], extra-temporal lobe [ETL] or hemispheric surgery), pathologies, non-lesional epilepsy and incomplete resection were estimated. Meta-regression assessed the relationship between age at surgery, age at seizure onset and seizure outcome. Random-effects network meta-analysis was conducted for surgery locations.

Results: 258 studies were included. Surgery achieved higher seizure freedom than medical therapy (OR=6.49 [95%CI: 2.87, 14.70], p<0.001). Seizure freedom declined over time after surgery, from 64.8% (95%CI: 51.2%, 76.4%; p=0.034) at 1 year, to 60.3%...