Liu Shi-Yong, Yang Xiao-Lin, Chen Bing, Hou Zhi, An Ning, Yang Mei-Hua, Yang Hui
From the Epilepsy Center of PLA, Department of Neurosurgery, Xinqiao Hospital, the Third Military Medical University, Chongqing, China.
Medicine (Baltimore). 2015 Feb;94(6):e500. doi: 10.1097/MD.0000000000000500.
Surgery for refractory epilepsy is widely used but the efficacy of this treatment for providing a seizure-free outcome and better quality of life remains unclear.This study aimed to update current evidence and to evaluate the effects of surgery on quality of life in patients with refractory epilepsy.A systematic review and meta-analysis of the literature were conducted and selected studies included 2 groups of refractory epilepsy patients, surgical and nonsurgical.The studies were assessed using the Newcastle-Ottawa Scale. The primary outcome was the seizure-free rate. The secondary outcome was quality of life. Adverse events were also reviewed.After screening, a total of 20 studies were selected: 8 were interventional, including 2 randomized controlled trials, and 12 were observational. All of the studies comprised 1959 patients with refractory epilepsy. The seizure-free rates were significantly higher for patients who received surgery compared with the patients who did not; the combined odds ratio was 19.35 (95% CI = 12.10-30.95, P < 0.001). After adjusting for publication bias the combined odds ratio was 10.25 (95% CI = 5.84-18.00). In both the interventional and observational studies, patients treated surgically had a significantly better quality of life compared with the patients not treated surgically. Complications were listed in 3 studies and the rates were similar in surgical and nonsurgical patients.Our meta-analysis found that for patients with refractory epilepsy, surgical treatment appears to provide a much greater likelihood of seizure-free outcome than nonsurgical treatment, although there is a need for more studies, particularly randomized studies, to confirm this conclusion. Based on more limited data, surgical treatment also appeared to provide a better quality of life and did not seem to increase complications.
难治性癫痫的手术治疗应用广泛，但这种治疗在实现无癫痫发作及改善生活质量方面的疗效仍不明确。本研究旨在更新现有证据，并评估手术对难治性癫痫患者生活质量的影响。我们对文献进行了系统回顾和荟萃分析，纳入的研究包括两组难治性癫痫患者，即手术组和非手术组。使用纽卡斯尔-渥太华量表对研究进行评估。主要结局是无癫痫发作率。次要结局是生活质量。还对不良事件进行了回顾。筛选后，共选取了20项研究：8项为干预性研究，包括2项随机对照试验，12项为观察性研究。所有研究共纳入1959例难治性癫痫患者。与未接受手术的患者相比，接受手术的患者无癫痫发作率显著更高；合并比值比为19.35（95%CI = 12.10 - 30.95，P < 0.001）。校正发表偏倚后，合并比值比为10.25（95%CI = 5.84 - 18.00）。在干预性研究和观察性研究中，接受手术治疗的患者生活质量均显著优于未接受手术治疗的患者。3项研究列出了并发症情况，手术患者和非手术患者的并发症发生率相似。我们的荟萃分析发现，对于难治性癫痫患者，手术治疗实现无癫痫发作结局的可能性似乎比非手术治疗大得多，不过仍需要更多研究，尤其是随机研究来证实这一结论。基于更有限的数据，手术治疗似乎也能带来更好的生活质量，且似乎不会增加并发症。
