Hou Zhi, Duan Qing-Tian, Ke Yan-Yan, An Ning, Yang Hui, Liu Shi-Yong, Zhang Chun-Qing
Department of Neurosurgery, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Front Neurol. 2021 Aug 18;12:668439. doi: 10.3389/fneur.2021.668439. eCollection 2021.
Central nervous system infections (CNSIs), especially viral encephalitis and meningitis, are well-recognized causes of medically refractory epilepsy. Although surgery is an effective and durable intervention against these infections, the seizure control outcomes described in previous surgical series have been variable. Accordingly, it is not clear which variables are most valuable in predicting seizure control following surgery for CNSI. The aim of this meta-analysis was to identify the predictors of favorable surgical outcomes in CNSI-related epilepsy. The PubMed, EMBASE, Cochrane Library, WANGFANG, VIP, CBM, and CNKI databases were searched for studies according to the inclusion criteria. Prognostic factors, surgical outcomes, and patient characteristics were extracted. Heterogeneity was detected by the I and Q statistics. Seventeen studies were included in our meta-analysis. Eight predictors of favorable outcomes (Engel Class I/II) were determined, including abnormal MRI findings, meningitis, temporal location only, regional ictal pattern, unilateral ictal pattern, older age at epilepsy, longer silent period, and longer time from infection, as follows: OR = 3.34 (95% CI 1.44-7.74), OR = 0.31 (95% CI 0.13-0.70), OR = 0.34 (95% CI 0.16-0.74), OR = 5.65 (95% CI 1.75-18.30), and OR = 9.53 (95% CI 2.36-38.48), respectively, and MD = 2.15 (95% CI 0.20-4.11), MD = 2.40 (95% CI 0.09-4.70), and MD = 8.49 (95% CI 1.50-15.48), respectively. A subgroup analysis found the following associations: regional and unilateral ictal patterns in viral encephalitis, a younger age at infection in parasitic encephalopathy, an older age at surgery, a longer time from onset, and a longer time from infection in unexplained meningitis. A sensitivity analysis restricted to studies that included each variable yielded robust results. Little evidence of publication bias was observed. This meta-analysis suggests that abnormal MRI findings, meningitis, temporal location only, regional and unilateral ictal patterns, older age at epilepsy, longer silent period, and longer time from infection are predictive factors in patients with favorable surgical outcomes in CNSI-related epilepsy. In addition, different infective agents influenced the results in regional and unilateral ictal patterns in ictal electroencephalography, as well as the relationship between age at infection and surgery and the time from epilepsy onset and infection.
中枢神经系统感染（CNSIs），尤其是病毒性脑炎和脑膜炎，是公认的导致药物难治性癫痫的原因。尽管手术是针对这些感染的一种有效且持久的干预措施，但先前手术系列报道的癫痫控制效果却不尽相同。因此，目前尚不清楚哪些变量对于预测CNSI手术后的癫痫控制最有价值。本荟萃分析的目的是确定CNSI相关性癫痫手术良好预后的预测因素。根据纳入标准，检索了PubMed、EMBASE、Cochrane图书馆、万方、维普、中国生物医学文献数据库和中国知网数据库中的研究。提取了预后因素、手术结果和患者特征。通过I统计量和Q统计量检测异质性。我们的荟萃分析纳入了17项研究。确定了8个良好预后（Engel I/II级）的预测因素，包括MRI异常表现、脑膜炎、仅颞叶部位、局部发作模式、单侧发作模式、癫痫发病时年龄较大、发作间期较长以及感染后时间较长，具体如下：优势比（OR）分别为3.34（95%置信区间1.44 - 7.74）、0.31（95%置信区间0.13 - 0.70）、0.34（95%置信区间0.16 - 0.74）、5.65（95%置信区间1.75 - 18.30）和9.53（95%置信区间2.36 - 38.48），平均差（MD）分别为2.15（95%置信区间0.20 - 4.11）、2.40（95%置信区间0.09 - 4.70）和8.49（95%置信区间1.50 - 15.48）。亚组分析发现了以下关联：病毒性脑炎中的局部和单侧发作模式、寄生虫性脑病中感染时年龄较小、手术时年龄较大、发病时间较长以及不明原因脑膜炎中感染后时间较长。对包含每个变量的研究进行的敏感性分析得出了可靠的结果。未观察到明显的发表偏倚证据。本荟萃分析表明，MRI异常表现、脑膜炎、仅颞叶部位、局部和单侧发作模式、癫痫发病时年龄较大、发作间期较长以及感染后时间较长是CNSI相关性癫痫手术预后良好患者的预测因素。此外，不同的感染因子影响了发作期脑电图中的局部和单侧发作模式结果，以及感染时年龄与手术之间的关系和癫痫发作与感染之间的时间关系。
