Feng E-S, Sui C-B, Wang T-X, Sun G-L
Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beihai Hospital, Yantai, Shandong, China.
Acta Neurol Scand. 2016 Dec;134(6):442-451. doi: 10.1111/ane.12562. Epub 2016 Feb 4.
Stereotactic radiosurgery (RS) is a potential option for some patients with temporal lobe epilepsy (TLE). The aim of this meta-analysis was to determine the pooled seizure-free rate and the time interval to seizure cessation in patients with lesions in the mesial temporal lobe, and who were eligible for either stereotactic or gamma knife RS.
MATERIALS & METHODS: We searched the Medline, Cochrane, EMBASE, and Google Scholar databases using combinations of the following terms: RS, stereotactic radiosurgery, gamma knife, and TLE.
We screened 103 articles and selected 13 for inclusion in the meta-analysis. Significant study heterogeneity was detected; however, the included studies displayed an acceptable level of quality. We show that approximately half of the patients were seizure free over a follow-up period that ranged from 6 months to 9 years [pooled estimate: 50.9% (95% confidence interval: 0.381-0.636)], with an average of 14 months to seizure cessation [pooled estimate: 14.08 months (95% confidence interval: 11.95-12.22 months)]. Nine of 13 included studies reported data for adverse events (AEs), which included visual field deficits and headache (the two most common AEs), verbal memory impairment, psychosis, psychogenic non-epileptic seizures, and dysphasia. Patients in the individual studies experienced AEs at rates that ranged from 8%, for non-epileptic seizures, to 85%, for headache.
Our findings indicate that RS may have similar or slightly less efficacy in some patients compared with invasive surgery. Randomized controlled trials of both treatment regimens should be undertaken to generate an evidence base for patient decision-making.
立体定向放射外科手术（RS）是一些颞叶癫痫（TLE）患者的潜在选择。本荟萃分析的目的是确定内侧颞叶有病变且符合立体定向或伽玛刀RS治疗条件的患者的汇总无癫痫发作率和癫痫发作停止的时间间隔。
我们使用以下术语组合在Medline、Cochrane、EMBASE和谷歌学术数据库中进行检索：RS、立体定向放射外科手术、伽玛刀和TLE。
我们筛选了103篇文章，选择了13篇纳入荟萃分析。检测到显著的研究异质性；然而，纳入的研究显示出可接受的质量水平。我们发现，在6个月至9年的随访期内，约一半的患者无癫痫发作[汇总估计：50.9%（95%置信区间：0.381 - 0.636）]，癫痫发作停止的平均时间为14个月[汇总估计：14.08个月（95%置信区间：11.95 - 12.22个月）]。13项纳入研究中有9项报告了不良事件（AE）的数据，包括视野缺损和头痛（两种最常见的AE）、言语记忆障碍、精神病、心因性非癫痫性发作和吞咽困难。各研究中的患者发生AE的比率从非癫痫性发作的8%到头痛的85%不等。
我们的研究结果表明，与侵入性手术相比，RS在某些患者中的疗效可能相似或略低。应开展两种治疗方案的随机对照试验，为患者决策提供证据基础。
