胼胝体切开术治疗难治性癫痫痉挛：系统回顾和荟萃分析。

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Seizure-European Journal of Epilepsy Pub Date : 2024-11-07 DOI:10.1016/j.seizure.2024.11.001

Robyn Whitney , Hiroshi Otsubo , Jessie Cunningham , Kevin C. Jones , Rajesh RamachandranNair , Maryam Nabavi Nouri , Elizabeth J Donner , George M Ibrahim , Ravindra Arya , Puneet Jain

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引用次数: 0

摘要

目的：我们系统回顾了有关胼胝体切开术（CC）对难治性癫痫性痉挛（ES）儿童和成人疗效的现有文献，并分析了癫痫发作结果的临床决定因素：方法：我们遵循《系统综述和荟萃分析指南首选报告项目》（PRISMA）。我们系统检索了 MEDLINE、EMBASE 和 Cochrane 数据库中截至 2023 年 12 月有关使用 CC 治疗难治性 ES 的原始研究文章。研究的主要结果指标是在最近一次随访中，首次使用 CC 后获得癫痫发作自由的研究参与者比例。采用混合效应模型进行元回归，以获得癫痫发作结果的临床决定因素：共纳入了 12 项研究（253 人）。最常见的是初始完全CC（n = 218/253，86%），其次是前部CC（n = 29/253，12%）和其他形式的CC（即前部到后部、后部、分期完全）（n = 6/253，2%）。CC 治疗后实现无痉挛的患者总比例为 0.31（95% CI：0.22，0.42）（平均随访 47 个月）。元回归结果表明，结构性病因和CC时的平均年龄对汇总效应有显著的调节作用。结构性病因的比例每增加 1%，无痉挛结果的比例就会降低 0.45（95% CI：-0.86, -0.03，p < 0.0001）。此外，平均年龄增加 1 个月会导致无痉挛患者比例减少 0.003（95% CI：-0.005，-0.0006，p = 0.01）。七项研究中有62人（24%）因ES残留而接受了进一步手术，其中34人（55%）摆脱了痉挛：结论：对某些难治性癫痫痉挛患者而言，胼胝体切开术可能是一种有效的治疗方法。结构性病因和胼胝体切开术时年龄的增加是重要的临床决定因素。在某些情况下，胼胝体切开术可能会导致进一步的癫痫手术。

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Corpus callosotomy for refractory epileptic spasms: Systematic review and meta-analysis

Objective

We systematically reviewed the existing literature on the efficacy of corpus callosotomy (CC) in children and adults with refractory epileptic spasms (ES) and analyzed clinical determinants of seizure outcomes.

Methods

The Preferred Report Items for Systematic Reviews and Meta-Analysis Guidelines (PRISMA) were followed. We systematically searched MEDLINE, EMBASE and Cochrane databases up to December 2023 for original research articles on using CC to treat refractory ES. The primary outcome measure was the proportion of study participants who achieved seizure freedom following initial CC at the last follow-up. Meta-regression using mixed-effects models was performed to obtain clinical determinants of seizure outcomes.

Results

A total of 12 studies were included (253 individuals). Initial complete total CC was most common (n = 218/253, 86%), followed by anterior CC (n = 29/253, 12%) and other forms of CC (i.e., anterior to posterior, posterior, staged total) (n = 6/253, 2%). The pooled proportion of patients achieving spasm freedom following CC was 0.31 (95% CI: 0.22, 0.42) (mean follow-up 47 months). Meta-regression showed that structural etiology and mean age at the time of CC were significant moderators of the pooled effect. For every 1% increase in the proportion of structural etiology, the proportion of spasm-free outcome was found to reduce by 0.45 (95% CI: -0.86, -0.03, p < 0.0001). In addition, increasing the mean age by 1 month led to a reduction in the proportion of spasms-free patients by 0.003 (95% CI: -0.005, -0.0006, p = 0.01). Sixty-two individuals (24%) from seven studies underwent further surgery for residual ES; 34 became spasm free (55%).

Conclusions

Corpus callosotomy may be an effective treatment option in selected individuals with refractory epileptic spasms. Structural aetiologies and increased age at the time of corpus callosotomy are important clinical determinants. In some cases, CC may lead to further epilepsy surgery.

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来源期刊

Seizure-European Journal of Epilepsy 医学-临床神经学

CiteScore

5.60

自引率

6.70%

发文量

231

审稿时长

34 days

期刊介绍： Seizure - European Journal of Epilepsy is an international journal owned by Epilepsy Action (the largest member led epilepsy organisation in the UK). It provides a forum for papers on all topics related to epilepsy and seizure disorders.