Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK
Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
J Neurol Neurosurg Psychiatry. 2022 May;93(5):499-508. doi: 10.1136/jnnp-2021-327119. Epub 2022 Mar 4.
Accurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are consistently prognostic and should be included in the future models.
We searched PubMed and Cochrane using free-text and Medical Subject Heading (MeSH) terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study was registered on PROSPERO. We classified features as prognostic, non-prognostic and uncertain and into seven subcategories: 'clinical', 'imaging', 'neurophysiology', 'multimodal concordance', 'genetic', 'surgical technique' and 'pathology'. We propose a structural causal model based on these features.
We found 46 features from 38 meta-analyses over 22 years. The following were consistently prognostic across meta-analyses: febrile convulsions, hippocampal sclerosis, focal abnormal MRI, Single-Photon Emission Computed Tomography (SPECT) coregistered to MRI, focal ictal/interictal EEG, EEG-MRI concordance, temporal lobe resections, complete excision, histopathological lesions, tumours and focal cortical dysplasia type IIb. Severe learning disability was predictive of poor prognosis. Others, including sex and side of resection, were non-prognostic. There were limited meta-analyses investigating genetic contributions, structural connectivity or multimodal concordance and few adjusted for known confounders or performed corrections for multiple comparisons.
Seizure-free outcomes have not improved over decades of epilepsy surgery and despite a multitude of models, none prognosticate accurately. Our list of multimodal population-invariant prognostic features and proposed structural causal model may serve as an objective foundation for statistical adjustments of plausible confounders for use in high-dimensional models.
CRD42021185232.
对于局灶性耐药性癫痫患者的手术治疗后达到无癫痫发作的准确术前预测仍然难以实现。我们的目的是系统地评估所有以无癫痫发作作为主要结局的癫痫手术的荟萃分析，以确定具有一致性预后作用的临床特征，并将其纳入未来的模型中。
我们根据系统评价和荟萃分析的首选报告项目，使用自由文本和医学主题词（MeSH）术语在 PubMed 和 Cochrane 中进行搜索。本研究已在 PROSPERO 上注册。我们将特征分为预后、非预后和不确定，并分为七个亚类：“临床”、“影像学”、“神经生理学”、“多模态一致性”、“遗传学”、“手术技术”和“病理学”。我们基于这些特征提出了一个结构因果模型。
我们从 22 年来的 38 项荟萃分析中找到了 46 个特征。以下特征在多项荟萃分析中具有一致性的预后作用：热性惊厥、海马硬化、局灶性异常 MRI、单光子发射计算机断层扫描（SPECT）与 MRI 配准、局灶性癫痫发作/发作间期 EEG、EEG-MRI 一致性、颞叶切除术、完全切除、组织病理学病变、肿瘤和局灶性皮质发育不良 IIb 型。严重的学习障碍预示着预后不良。其他因素，包括性别和切除侧，是非预后性的。有一些荟萃分析研究了遗传因素、结构连接或多模态一致性，但很少有研究调整已知的混杂因素或进行多重比较的校正。
尽管已经进行了数十年的癫痫手术，但无癫痫发作的结果并没有改善，尽管有多种模型，但没有一种能准确预测。我们列出的多模态人群不变的预后特征和提出的结构因果模型可以作为统计调整可能混杂因素的客观基础，用于高维模型。
PROSPERO 注册号：CRD42021185232。
