Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Office of Research, University of Nevada, Las vegas, Nevada, USA.
J Neurol Neurosurg Psychiatry. 2022 Feb;93(2):133-143. doi: 10.1136/jnnp-2021-326185. Epub 2021 Jul 28.
BACKGROUND: Approximately 1/3 of patients with epilepsy have drug-resistant epilepsy (DRE) and require surgical interventions. This meta-analysis aimed to review the effectiveness of MRI-guided laser interstitial thermal therapy (MRgLITT) in DRE. METHODS: The Population, Intervention, Comparator and Outcome approach and Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. PubMed, MEDLINE and EMBASE databases were systematically searched for English language publications from 2012 to Nov 2020. Data on the prevalence outcome using the Engel Epilepsy Surgery Outcome Scale (Class I-IV), and postoperative complications were analysed with 95% CIs. RESULTS: Twenty-eight studies that included a total of 559 patients with DRE were identified. The overall prevalence of Engel class I outcome was 56% (95% CI 0.52% to 0.60%). Hypothalamic hamartomas (HH) patients had the highest seizure freedom rate of 67% (95% CI 0.57% to 0.76%) and outcome was overall comparable between mesial temporal lobe epilepsy (mTLE) (56%, 95% CI 0.50% to 0.61%) and extratemporal epilepsy (50% 95% CI 0.40% to 0.59%). The mTLE cases with mesial temporal sclerosis had better outcome vs non-lesional cases of mTLE. The prevalence of postoperative adverse events was 19% (95% CI 0.14% to 0.25%) and the most common adverse event was visual field deficits. The reoperation rate was 9% (95% CI 0.05% to 0.14%), which included repeat ablation and open resection. CONCLUSION: MRgLITT is an effective and safe intervention for DRE with different disease aetiologies. The seizure freedom outcome is overall comparable in between extratemporal and temporal lobe epilepsy; and highest with HH. TRAIL REGISTRATION NUMBER: The study protocol was registered with the National Institute for Health Research (CRD42019126365), which serves as a prospective register of systematic reviews. It is an international database of prospectively registered systematic reviews with a focus on health-related outcomes. Details about the protocol can be found at https://wwwcrdyorkacuk/PROSPERO/.
背景：约有 1/3 的癫痫患者患有耐药性癫痫（DRE），需要手术干预。本荟萃分析旨在回顾磁共振引导激光间质热疗（MRgLITT）在 DRE 中的疗效。
方法：采用人群、干预、对照和结局方法，并遵循系统评价和荟萃分析的首选报告项目。从 2012 年至 2020 年 11 月，系统地检索了英文文献的 PubMed、MEDLINE 和 EMBASE 数据库。使用恩格尔癫痫手术结局量表（I-IV 级）分析了患病率结局数据，并用 95%CI 分析了术后并发症。
结果：确定了 28 项共纳入 559 例 DRE 患者的研究。总体而言，恩格尔 I 级结局的患病率为 56%（95%CI 0.52%至 0.60%）。下丘脑错构瘤（HH）患者的癫痫无发作率最高，为 67%（95%CI 0.57%至 0.76%），且在颞叶内侧癫痫（mTLE）（56%，95%CI 0.50%至 0.61%）和颞叶外癫痫（50%，95%CI 0.40%至 0.59%）之间的结果总体相似。伴有内侧颞叶硬化的 mTLE 病例的结局优于非病变性 mTLE 病例。术后不良事件的发生率为 19%（95%CI 0.14%至 0.25%），最常见的不良事件是视野缺损。再手术率为 9%（95%CI 0.05%至 0.14%），包括重复消融和开放切除。
结论：MRgLITT 是一种有效且安全的治疗不同病因 DRE 的方法。在颞叶外和颞叶癫痫之间，癫痫无发作的结果总体相似；而 HH 的结果最好。
试验注册号：该研究方案在英国国家卫生研究院（CRD42019126365）注册，该方案是系统评价的前瞻性登记处。它是一个专注于健康相关结局的国际前瞻性系统评价数据库。可以在 https://wwwcrdyorkacuk/PROSPERO/ 找到方案的详细信息。
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