SEIN - Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
UMC Utrecht Brain Center, University Medical Center Utrecht, Department of (Child) Neurology and Neurosurgery, Utrecht University, the Netherlands, member of ERN EpiCARE
Epileptic Disord. 2022 Dec 1;24(6):1033-1045. doi: 10.1684/epd.2022.1484.
Presurgical long-term video-EEG monitoring (LT-VEEG) is an important part of the presurgical evaluation in patients with focal epilepsy. Multiple seizures need to be recorded, often in limited time and with the need to taper anti-seizure medication (ASM). The aim of this study was to systematically study the yield – in terms of success – and risks associated with presurgical LT-VEEG, and to identify all previously reported contributing variables.
A systematic review of the databases of PubMed Medline, Embase, Cochrane Central, and the Cochrane Database of Systematic Reviews were searched following the Preferred Reporting Items for Systematic Reviews (PRISMA) guideline. Publications about presurgical LT-VEEG reporting on variables contributing to yield and risk were included. Study characteristics of all included studies were extracted following a standardized template. Within these articles, studies presenting multivariable analyses of factors contributing to the risk of adverse events or the success of LT-VEEG were identified.
We found 36 articles reporting on LT-VEEG, including 4,703 presurgical patients, both children and adults. Presurgical LT-VEEG monitoring led to an average yield of 85%. Adverse events occurred with an averaged total event rate of 17%, but the type of included events was variable among studies. Factors reported to independently contribute to successful LT-VEEG were: baseline seizure frequency, a shorter interval from the most recent seizure, extratemporal lobe epilepsy, and no requirement for ASM reduction. Factors independently contributing to the occurrence of adverse events were: ASM tapering, a history of status epilepticus, a history of focal to bilateral tonic-clonic seizures, psychiatric comorbidity, and ASM taper rate.
This study reveals that the data on factors contributing to yield and risk of adverse events is significant and variable, and often reported with inadequate statistics. Future research is warranted to develop guidelines for ASM withdrawal during presurgical video-EEG monitoring, taking predefined factors for success and risks of adverse events into account.
术前长期视频脑电图监测（LT-VEEG）是局灶性癫痫患者术前评估的重要组成部分。需要记录多次发作，通常时间有限，并且需要逐渐减少抗癫痫药物（ASM）。本研究的目的是系统地研究与术前 LT-VEEG 相关的收益（成功率）和风险，并确定所有先前报道的相关变量。
根据首选报告项目的系统评价（PRISMA）指南，对 PubMed Medline、Embase、Cochrane Central 和 Cochrane 系统评价数据库进行系统检索。纳入报告与收益和风险相关的变量对术前 LT-VEEG 贡献的研究。根据标准化模板提取所有纳入研究的研究特征。在这些文章中，确定了分析导致不良事件风险或 LT-VEEG 成功率的因素的多变量分析。
我们发现了 36 篇关于 LT-VEEG 的文章，其中包括 4703 名接受手术的患者，包括儿童和成人。术前 LT-VEEG 监测的平均成功率为 85%。不良事件的总发生率平均为 17%，但各研究中所包括的不良事件类型不同。被报道为独立影响 LT-VEEG 成功率的因素包括：基线发作频率、最近一次发作与 LT-VEEG 之间的间隔较短、颞叶外癫痫和无需减少 ASM。独立影响不良事件发生的因素包括：ASM 逐渐减少、癫痫持续状态史、局灶性至双侧强直阵挛性发作史、精神共病和 ASM 逐渐减少率。
本研究表明，与收益和不良事件风险相关的因素的数据是重要且多变的，并且往往报道的统计数据不足。需要进一步研究，以制定在术前视频脑电图监测期间减少 ASM 的指南，考虑到成功和不良事件风险的预设因素。
