TY - JOUR
T1 - Palliative surgery for drug resistant epilepsy in adult patients. A systematic review of the literature and a pooled analysis of outcomes
AU - Caccavella, Valerio Maria
AU - Giordano, Martina
AU - Colicchio, Gabriella
AU - Izzo, Alessandro
AU - D'Ercole, Manuela
AU - Rapisarda, Alessandro
AU - Polli, Filippo Maria
AU - Fuggetta, Filomena
AU - Olivi, Alessandro
AU - Montano, Nicola
PY - 2022
Y1 - 2022
N2 - Background: Several types of palliative surgery to treat drug resistant epilepsy (DRE) have been reported, but the evidence that is currently available is insufficient to help physicians redirect DRE patients to the most appropriate kind of surgery.
Methods: A systematic search in the PubMed and Scopus databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to compare different clinical features, outcomes and complications of adult patients submitted to callosotomy, vagal nerve stimulation (VNS), multiple subpial transections (MST), deep brain stimulation (DBS) or responsive neurostimulation (RNS).
Results: After screening 3447 articles, 36 studies were selected, including the data of 1628 patients: 76 were treated with callosotomy, 659 were treated with VNS, 416 were treated with DBS, and 477 were treated with RNS. No studies including patients treated with MST met the inclusion criteria. The global weighted average seizure frequency reduction was 50.23%, while the global responder rate was 52.12%. There were significant differences among the palliative surgical procedures in term of clinical features of patients and epilepsy, seizure frequency reduction and percentage of responders. Complications were differently distributed as well.
Conclusions: Our analysis highlights the necessity of prospective studies, possibly randomized controlled trials, to compare different forms of palliative epilepsy surgery. Moreover, by identifying the outcome predictors associated with each technique, the "best responder" may be profiled for each procedure.
AB - Background: Several types of palliative surgery to treat drug resistant epilepsy (DRE) have been reported, but the evidence that is currently available is insufficient to help physicians redirect DRE patients to the most appropriate kind of surgery.
Methods: A systematic search in the PubMed and Scopus databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to compare different clinical features, outcomes and complications of adult patients submitted to callosotomy, vagal nerve stimulation (VNS), multiple subpial transections (MST), deep brain stimulation (DBS) or responsive neurostimulation (RNS).
Results: After screening 3447 articles, 36 studies were selected, including the data of 1628 patients: 76 were treated with callosotomy, 659 were treated with VNS, 416 were treated with DBS, and 477 were treated with RNS. No studies including patients treated with MST met the inclusion criteria. The global weighted average seizure frequency reduction was 50.23%, while the global responder rate was 52.12%. There were significant differences among the palliative surgical procedures in term of clinical features of patients and epilepsy, seizure frequency reduction and percentage of responders. Complications were differently distributed as well.
Conclusions: Our analysis highlights the necessity of prospective studies, possibly randomized controlled trials, to compare different forms of palliative epilepsy surgery. Moreover, by identifying the outcome predictors associated with each technique, the "best responder" may be profiled for each procedure.
KW - callosotomy
KW - deep brain stimulation
KW - drug resistant epilepsy
KW - epilepsy surgery
KW - responsive neurostimulation
KW - vagal nerve stimulation
KW - callosotomy
KW - deep brain stimulation
KW - drug resistant epilepsy
KW - epilepsy surgery
KW - responsive neurostimulation
KW - vagal nerve stimulation
UR - http://hdl.handle.net/10807/199806
U2 - 10.1016/j.wneu.2022.03.058
DO - 10.1016/j.wneu.2022.03.058
M3 - Article
SN - 1878-8750
SP - N/A-N/A
JO - World Neurosurgery
JF - World Neurosurgery
ER -