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Rates and predictors of long-term seizure freedom after frontal lobe epilepsy surgery: a systematic review and meta-analysis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Englot, Dario J. Wang, Doris D. Rolston, John D. Shih, Tina T. Chang, Edward F.
Description	Country affiliation: United States Author Affiliation: Englot DJ ( Department of Neurological Surgery, University of California, San Francisco, California 94143-0112, USA. englotdj@neurosurg.ucsf.edu)
Abstract	OBJECT: Frontal lobe epilepsy (FLE) is the second-most common focal epilepsy syndrome, and seizures are medically refractory in many patients. Although various studies have examined rates and predictors of seizure freedom after resection for FLE, there is significant variability in their results due to patient diversity, and inadequate follow-up may lead to an overestimation of long-term seizure freedom. METHODS: In this paper the authors report a systematic review and meta-analysis of long-term seizure outcomes and predictors of response after resection for intractable FLE. Only studies of at least 10 patients examining seizure freedom after FLE surgery with postoperative follow-up duration of at least 48 months were included. RESULTS: Across 1199 patients in 21 studies, the overall rate of postoperative seizure freedom (Engel Class I outcome) was 45.1%. No trend in seizure outcomes across all studies was observed over time. Significant predictors of long-term seizure freedom included lesional epilepsy origin (relative risk [RR] 1.67, 95% CI 1.36-28.6), abnormal preoperative MRI (RR 1.64, 95% CI 1.32-2.08), and localized frontal resection versus more extensive lobectomy with or without an extrafrontal component (RR 1.71, 95% CI 1.26-2.43). Within lesional FLE cases, gross-total resection led to significantly improved outcome versus subtotal lesionectomy (RR 1.99, 95% CI 1.47-2.84). CONCLUSIONS: These findings suggest that FLE patients with a focal and identifiable lesion are more likely to achieve seizure freedom than those with a more poorly defined epileptic focus. While seizure freedom can be achieved in the surgical treatment of medically refractory FLE, these findings illustrate the compelling need for improved noninvasive and invasive localization techniques in FLE.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	5
Volume Number	116
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2012-05-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Epilepsy, Frontal Lobe Surgery Neurosurgical Procedures Seizures Drug Resistance Electroencephalography Etiology Frontal Lobe Functional Laterality Physiology Magnetic Resonance Imaging Positron-emission Tomography Predictive Value Of Tests Meta-analysis
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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