Joiner Evan F, Youngerman Brett E, Hudson Taylor S, Yang Jingyan, Welch Mary R, McKhann Guy M, Neugut Alfred I, Bruce Jeffrey N
1Department of Neurological Surgery.
2Department of Epidemiology, Mailman School of Public Health, and.
J Neurosurg. 2018 Apr 27;130(4):1274-1282. doi: 10.3171/2017.10.JNS172236. Print 2019 Apr 1.
The purpose of this meta-analysis was to evaluate the impact of perioperative antiepileptic drug (AED) prophylaxis on short- and long-term seizure incidence among patients undergoing brain tumor surgery. It is the first meta-analysis to focus exclusively on perioperative AED prophylaxis among patients undergoing brain tumor surgery.
The authors searched PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and the System for Information on Gray Literature in Europe for records related to perioperative AED prophylaxis for patients with brain tumors. Risk of bias in the included studies was assessed using the Cochrane risk of bias tool. Incidence rates for early seizures (within the first postoperative week) and total seizures were estimated based on data from randomized controlled trials. A Mantel-Haenszel random-effects model was used to analyze pooled relative risk (RR) of early seizures (within the first postoperative week) and total seizures associated with perioperative AED prophylaxis versus control.
Four RCTs involving 352 patients met the criteria of inclusion. The results demonstrated that perioperative AED prophylaxis for patients undergoing brain tumor surgery provides a statistically significant reduction in risk of early postoperative seizures compared with control (RR = 0.352, 95% confidence interval 0.130-0.949, p = 0.039). AED prophylaxis had no statistically significant effect on the total (combined short- and long-term) incidence of seizures.
This meta-analysis demonstrates for the first time that perioperative AED prophylaxis for brain tumor surgery provides a statistically significant reduction in early postoperative seizure risk.
本荟萃分析旨在评估围手术期抗癫痫药物（AED）预防性治疗对脑肿瘤手术患者短期和长期癫痫发作发生率的影响。这是首个专门聚焦于脑肿瘤手术患者围手术期AED预防性治疗的荟萃分析。
作者检索了PubMed/MEDLINE、Embase、Cochrane对照试验中央注册库、clinicaltrials.gov以及欧洲灰色文献信息系统，以获取与脑肿瘤患者围手术期AED预防性治疗相关的记录。使用Cochrane偏倚风险工具评估纳入研究中的偏倚风险。基于随机对照试验的数据估算早期癫痫发作（术后第一周内）和总癫痫发作的发生率。采用Mantel-Haenszel随机效应模型分析围手术期AED预防性治疗与对照相比，早期癫痫发作（术后第一周内）和总癫痫发作的合并相对风险（RR）。
四项涉及352例患者的随机对照试验符合纳入标准。结果表明，与对照组相比，脑肿瘤手术患者围手术期使用AED预防性治疗可使术后早期癫痫发作风险在统计学上显著降低（RR = 0.352，95%置信区间0.130 - 0.949，p = 0.039）。AED预防性治疗对癫痫发作的总（短期和长期合并）发生率无统计学显著影响。
本荟萃分析首次表明，脑肿瘤手术围手术期使用AED预防性治疗可使术后早期癫痫发作风险在统计学上显著降低。
