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

Elysa Widjaja; Puneet Jain; Lindsay Demoe; Astrid Guttmann; George Tomlinson; Beate Sander

doi:10.1212/WNL.0000000000008966

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

Neurology. 2020 Feb 18;94(7):311-321. doi: 10.1212/WNL.0000000000008966. Epub 2020 Jan 29.

Authors

Elysa Widjaja¹, Puneet Jain², Lindsay Demoe², Astrid Guttmann², George Tomlinson², Beate Sander²

Affiliations

¹ From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.S.), University of Toronto, ON, Canada; Diagnostic Imaging (E.W.); Division of Neurology (E.W., P.J.); Neuroscience and Mental Health (L.D.), Hospital for Sick Children, Toronto; ICES (A.G., B.S.), Toronto, ON, Canada; Department of Pediatrics (A.G.), Hospital for Sick Children, Toronto, ON, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.S.), University Health Network, Toronto, ON, Canada; and Public Health Ontario (B.S.), Toronto, ON, Canada. Elysa.Widjaja@sickkids.ca.
² From the Institute of Health Policy, Management and Evaluation (E.W., A.G., G.T., B.S.), University of Toronto, ON, Canada; Diagnostic Imaging (E.W.); Division of Neurology (E.W., P.J.); Neuroscience and Mental Health (L.D.), Hospital for Sick Children, Toronto; ICES (A.G., B.S.), Toronto, ON, Canada; Department of Pediatrics (A.G.), Hospital for Sick Children, Toronto, ON, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative (G.T., B.S.), University Health Network, Toronto, ON, Canada; and Public Health Ontario (B.S.), Toronto, ON, Canada.

PMID: 31996452
DOI: 10.1212/WNL.0000000000008966

Abstract

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], extratemporal lobe [ETL], or hemispheric surgery), pathologies, nonlesional 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: Two hundred fifty-eight studies were included. Surgery achieved higher seizure freedom than medical therapy (odds ratio [OR] = 6.49 [95% confidence interval [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% (95% CI: 52.9%-67.4%; p = 0.007) at 5 years, and to 39.7% (95% CI: 28.4%-52.2%, p = 0.106) at 10 years. Seizure freedom was (1) highest for hemispheric surgery, followed by TL and ETL surgery, and (2) highest for tumor and lower for malformations of cortical development. Seizure freedom was lower for nonlesional than lesional epilepsy (OR = 0.54 [95% CI: 0.34, 0.88], p = 0.013) and incomplete than complete resection (OR = 0.13 [95% CI: 0.08, 0.21], p < 0.001). Age at surgery and age at seizure onset were associated with seizure freedom for mixed pathologies and surgery locations and TL surgery.

Conclusion: Epilepsy surgery was more effective than medical therapy to control seizures. Understanding seizure outcomes of different surgery locations, pathologies, nonlesional epilepsy, and incomplete resection will assist with presurgical counseling.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Child
Epilepsy / surgery*
Humans
Seizures / surgery*
Treatment Outcome