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Postoperative Neurologic Outcome in Patients Undergoing Resective Surgery for Parietal Lobe Epilepsy: A Systematic
Stuart Gates1, Dawn E Hackman1, Nitin Agarwal1
1From the University of Minnesota Medical School (S.G.), Minneapolis, MN; Dr. Martin Luther King, Jr. Library (D.E.H.), San José State University, San José, CA; Pediatric Epileptology (N.A.), Minnesota Epilepsy Group, Roseville; Pediatric Epileptology (N.A.), Children's Minnesota, Minneapolis; Neurology (W.Z., J.R.W.), Minnesota Epilepsy Group, Roseville; Neurology (W.Z.), United Hospital of Allina Health, St. Paul; Allina Health (P.B.); Center for Orphan Drug Research (J.R.W.), University of Minnesota; and Epileptology (J.R.W.), Abbott Northwestern Hospital, Minneapolis, MN.
Background And Objectives:
Parietal lobe epilepsy (PLE) surgery can be an effective treatment for selected patients with intractable epilepsy but can be associated with the risk of serious neurologic deficits. We performed a systematic review of the literature to obtain a comprehensive summary of the frequency and types of new postoperative neurologic deficits in patients undergoing PLE resective surgery.
Methods:
We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for articles published between January 1, 1990, and April 28, 2022. We included studies that reported postoperative neurologic outcome following PLE resective surgery confined to the parietal lobe. We required that studies included ≥5 patients. The data collected included demographic information and specific details of postoperative neurologic deficits. When available, individual patient data were collected. We used the Risk of Bias in Nonrandomized Studies of Interventions tool to assess the risk of bias and Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of the evidence.
Results:
Of the 3,461 articles screened, 33 studies met the inclusion criteria. A total of 370 patients were included. One hundred patients (27.0%) had a new deficit noted postoperatively. Approximately half of the patients with deficits experienced only transient deficits. Motor deficits were the most commonly identified deficit. The rates of motor deficits noted after PLE surgery were 5.7%, 3.2%, and 2.2% for transient, long-term, and duration not specified, respectively. Sensory and visual field deficits were also commonly reported. Gerstmann syndrome was noted postoperatively in 4.9% of patients and was almost always transient. Individual patient data added information on parietal lobe subregion postoperative neurologic outcome.
Discussion:
Our systematic review provides a comprehensive summary of the frequency and types of neurologic deficits associated with PLE surgery. A significant percentage of postoperative deficits are transient. In addition to the expected sensory and visual deficits, PLE surgery is associated with a notable risk of motor deficits. The available literature has important deficiencies. Our study highlights gaps in the literature and provides recommendations for future directions.
Trial Registration Information:
This systematic review was registered on PROSPERO (CRD42022313108, May 26, 2022).
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