Seizure Outcome After Surgery for MRI-Diagnosed Focal Cortical Dysplasia: A Systematic Review and Meta-analysis
Anna Willard1, Ana Antonic-Baker1, Zhibin Chen1
1From the Department of Neuroscience (A.W., A.A-B., Z.C., T.J.O., P.K., P.P.) and Clinical Epidemiology (Z.C.), School of Public Health and Preventive Medicine, Central Clinical School, Monash University; Department of Neurology (A.W., T.J.O., P.K., P.P.), Alfred Hospital; Departments of Neurology (A.W., T.J.O., P.K., P.P.) and Medicine (Z.C., T.J.O., P.K.), Royal Melbourne Hospital, and Department of Medicine (P.P.), Austin Health, University of Melbourne; and Comprehensive Epilepsy Program, Department of Neurology (P.P.), Austin Health, Melbourne, Victoria, Australia.
Background And Objectives:
Focal cortical dysplasia (FCD) has been associated with poorer postsurgical seizure outcomes compared to other pathologies. FCD surgical series have been assembled on the basis of a histologic diagnosis, including patients with abnormal and normal preoperative MRI. However, in clinical workflow, patient selection for surgery is based on preoperative findings, including MRI. We performed a systematic review and meta-analysis of the literature to determine the rate and predictors of favorable seizure outcome after surgery for MRI-detected FCD.
Methods:
We devised our study protocol in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered the protocol with PROSPERO. We searched MEDLINE, EMBASE, and Web of Science for studies of patients followed up for ≥12 months after resective surgery for drug-resistant epilepsy with MRI-detected FCD. Random-effects meta-analysis was used to calculate the proportion of patients attaining a favorable outcome, defined as Engel class I, International League Against Epilepsy class 1 to 2, or seizure-free status. Meta-regression was performed to investigate sources of heterogeneity.
Results:
Our search identified 3,745 references. Of these, 35 studies (total of 1,353 patients) were included. Most studies (89%) followed up patients for ≥24 months after surgery. The overall postsurgical favorable outcome rate was 70% (95% confidence interval [CI] 64-75). There was high interstudy heterogeneity. Favorable outcome was associated with complete resection of the FCD lesion (risk ratio [RR] 2.42 [95% confidence interval (CI) 1.55-3.76], p < 0.001) and location of the FCD lesion in the temporal lobe (RR 1.38 [95% CI 1.07-1.79], p = 0.013) but not lesion extent, intracranial EEG use, or FCD histologic type. The number of FCD histologic types included in the same study accounted for 7.6% of the observed heterogeneity.
Discussion:
Seventy percent of patients with drug-resistant epilepsy and MRI features of FCD attain a favorable seizure outcome after resective surgery. Our findings can be incorporated into routine preoperative counseling and reinforce the importance of completely resecting the MRI-detected FCD when safe and feasible.
Insights
Surgery for focal cortical dysplasia (FCD) in drug-resistant epilepsy yields a 70% favorable seizure outcome. Complete resection of the MRI-detected FCD lesion improves results, highlighting its importance for surgical planning.
Area of Science:
- Neurosurgery
- Epileptology
- Radiology
Background:
- Focal cortical dysplasia (FCD) is linked to poorer postsurgical seizure control.
- Surgical candidate selection relies on preoperative findings, including MRI.
- Previous studies often used histologic diagnosis, not solely preoperative MRI findings.
Purpose of the Study:
- To systematically review and meta-analyze the literature.
- To determine the rate of favorable seizure outcomes after surgery for MRI-detected FCD.
- To identify predictors of favorable seizure outcomes.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Searched MEDLINE, EMBASE, and Web of Science for relevant studies.
- Included studies with ≥12 months follow-up after resective surgery for drug-resistant epilepsy with MRI-detected FCD.
Main Results:
- Analyzed 35 studies comprising 1,353 patients.
- Overall favorable seizure outcome rate was 70% (95% CI 64-75).
- Complete FCD lesion resection (RR 2.42) and temporal lobe location (RR 1.38) predicted favorable outcomes.
Conclusions:
- 70% of patients with drug-resistant epilepsy and MRI-detected FCD achieve favorable seizure outcomes post-surgery.
- Complete resection of MRI-detected FCD is crucial for improving seizure control.
- Findings support incorporating these results into preoperative counseling and surgical planning.
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