George M Ibrahim, Aria Fallah, O Carter Snead, James T Rutka
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引用次数: 10
摘要
介绍。结节性硬化症(TS)是世界范围内遗传性癫痫的主要原因。在这里,我们评估了TS患儿在切除性癫痫手术后癫痫发作结局的变化。方法。对文献进行系统回顾,以确定报告TS患儿切除性癫痫手术后癫痫发作结果的研究。采用个体参与者荟萃分析方法,将癫痫发作结果和相关协变量相结合。多变量逻辑回归用于确定癫痫发作结果与手术时间之间的显著关联。结果。从1966年至今的20项研究,共186名参与者,符合本研究的纳入标准。单因素分析显示,过去15年内接受切除性癫痫手术的儿童癫痫发作结局与老年队列相比有显著改善(卡方4.1;P = 0.043)。在多变量分析中,调整随访时间后,这一趋势不显著(OR 0.52;95% ci 0.23-1.17;P = 0.11)。在过去的15年中,与年龄较大的队列相比,年龄较小的儿童也接受了切除手术的比例更高(OR 0.93;95% ci 0.89-0.97;P < 0.01)。结论。从1966年至今的多变量分析中观察到,TS切除手术后癫痫发作结果有改善的趋势。
Changing global trends in seizure outcomes following resective surgery for tuberous sclerosis in children with medically intractable epilepsy.
Introduction. Tuberous sclerosis (TS) is the leading cause of genetic epilepsy worldwide. Here, we evaluate changes in seizure outcomes following resective epilepsy surgery in children with TS over time. Methods. A systematic review of the literature was performed to identify studies reporting seizure outcomes following resective epilepsy surgery in children with TS. Using an individual participant meta-analysis approach, seizure outcomes and associated covariates were combined. Multivariate logistic regression was used to determine significant associations between seizure outcomes and time of surgery. Results. Twenty studies from 1966 to present, yielding 186 participants, met the inclusion criteria for the study. On univariate analysis, there was a significant improvement in seizure outcomes in children who underwent resective epilepsy surgery within the last 15 years compared to older cohorts (chi-square 4.1; P = 0.043). On multivariate analysis, adjusting for length of followup, this trend was not significant (OR 0.52; 95% CI 0.23-1.17; P = 0.11). In the last 15 years, a greater proportion of younger children also underwent resective surgery compared to older cohorts (OR 0.93; 95% CI 0.89-0.97; P < 0.01). Conclusions. A trend towards improved seizure outcomes following resective surgery for TS was observed from 1966 to present on multivariate analysis.