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&lt;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%...研究目的：本项系统综述及荟萃分析旨在评估儿童癫痫外科手术后的癫痫发作结局。 研究方法：检索MEDLINE、Embase及Cochrane数据库，纳入1990年至2017年间发表的儿童癫痫外科手术原创性研究。结局指标为随访12个月及以上时的无癫痫发作状态。采用随机效应模型，估算对照研究、不同手术部位（颞叶（temporal lobe, TL）、颞叶外（extra-temporal lobe, ETL）或大脑半球手术）、不同病理类型、非病灶性癫痫及不完全切除相关研究的效应量；采用元回归（meta-regression）分析评估手术年龄、癫痫起病年龄与癫痫发作结局之间的关联；针对手术部位开展随机效应网络荟萃分析（network meta-analysis）。 研究结果：最终纳入258项研究。癫痫外科手术的无癫痫发作率显著高于药物治疗（比值比（odds ratio, OR）=6.49，95%置信区间（confidence interval, CI）：2.87, 14.70，p<0.001）。术后无癫痫发作率随时间推移逐渐下降，术后1年时为64.8%（95%CI：51.2%, 76.4%; p=0.034），降至60.3%……