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Published on: August 16, 2024
Five-Year Long-Term Prognosis of Epileptic Children After Hemispheric Surgery: A Systematic Review and Meta-analysis
Kai Cao1, Meiling Liu, Chao Wang
1From the Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University (KC, CW, QL, KY, LT, XG); Beijing Municipal Key Laboratory of Clinical Epidemiology (KC, CW, QL, KY, LT, XG); Beijing Key Laboratory of Environment Toxicology (ML); School of Public Health, Capital Medical University (ML); and Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Laboratory (KC), Beijing, China.
Insights
Children undergoing hemispheric surgery for epilepsy have good long-term seizure control. Late seizure onset and abnormal MRI findings predict positive outcomes, offering hope for improved seizure-free status.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epilepsy Research
Background:
- Hemispheric surgery is a treatment option for refractory epilepsy in children.
- Estimating long-term seizure outcomes and identifying predictors is crucial for patient management.
Purpose of the Study:
- To evaluate long-term seizure outcomes in children after hemispheric surgery.
- To identify predictors associated with favorable seizure control post-surgery.
Main Methods:
- A systematic review and meta-analysis of 15 retrospective studies (380 patients) from 1995-2015.
- Patients were classified using the Engel scale; predictors were analyzed using Wilcoxon rank-sum and Chi-squared tests.
Main Results:
- 71% of children were seizure-free 5 years post-surgery.
- Late seizure onset (≥3.6 months) and abnormal MRI findings were significant positive predictors for seizure control.
- Late onset age increased the odds of positive outcomes by 2.65 times (P=0.001); abnormal MRI findings increased odds by 4.60 times (P=0.02).
Conclusions:
- Hemispheric surgery offers a good long-term prognosis for pediatric epilepsy.
- Late seizure onset and abnormal MRI findings are key positive predictors for successful long-term seizure control.
Abstract:
To estimate children's long-term seizure outcomes after hemispheric surgery and the associated predictors.A systematic review of 4 databases and a meta-analysis were performed from January 1, 1995 to August 31, 2015. The databases included PubMed, Embase, Science Direct, and Web of Science; patients were classified into the Engel Class I group and the Engel Class II to IV group, according to their seizure outcomes. Nine potential predictors were then stratified across the groups and estimated using the Wilcoxon rank-sum test for continuous variables and the Chi-squared test for categorical variables.The search yielded 15 retrospective studies, with a total sample size of 380. Five years after surgery, 268 (0.71, 95% confidence interval [CI]: 0.64-0.78) children were seizure free; the seizure onset age in the Engel Class I group was significantly higher than that of the Engel Class II to IV group (standardized mean difference [SMD] = 0.26, 95% CI: 0.03-0.49, P = 0.028); specifically, when predicting the positive long-term outcomes, the odds ratio for late onset age (≥3.6 months, median value of the Engel Class II-IV group) versus early onset age was 2.65 (95% CI: 1.454-4.836, z = 3.18, P = 0.001). The abnormal magnetic resonance imaging (MRI) findings were more predictive for positive seizure outcomes than the normal findings (odds ratio [OR] = 4.60, 95% CI: 1.27-16.62, P = 0.02).Following hemispheric surgery, the long-term prognosis of children with epilepsy was good. Late seizure onset (age ≥ 3.6 months) and abnormal MRI findings were positive predictors for long-term seizure control in children.
