Goel Keshav, Pek Valérie, Shlobin Nathan A, Chen Jia-Shu, Wang Andrew, Ibrahim George M, Hadjinicolaou Aristides, Roessler Karl, Dudley Roy W, Nguyen Dang K, El-Tahry Riëm, Fallah Aria, Weil Alexander G
David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA.
Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Epilepsia. 2023 Feb;64(2):253-265. doi: 10.1111/epi.17472. Epub 2022 Dec 12.
Despite the widespread use of intraoperative electrocorticography (iECoG) during resective epilepsy surgery, there are conflicting data on its overall efficacy and inability to predict benefit per pathology. Given the heterogeneity of iECoG use in resective epilepsy surgery, it is important to assess the utility of interictal-based iECoG. This individual patient data (IPD) meta-analysis seeks to identify the benefit of iECoG during resective epilepsy surgery in achieving seizure freedom for various pathologies. Embase, Scopus, and PubMed were searched from inception to January 31, 2021 using the following terms: "ecog", "electrocorticography", and "epilepsy". Articles were included if they reported seizure freedom at ≥12-month follow-up in cohorts with and without iECoG for epilepsy surgery. Non-English articles, noncomparative iECoG cohorts, and studies with <10% iECoG use were excluded. This meta-analysis followed the PRISMA 2020 guidelines. The primary outcome was seizure freedom at last follow-up and time to seizure recurrence, if applicable. Forest plots with random effects modeling assessed the relationship between iECoG use and seizure freedom. Cox regression of IPD was performed to identify predictors of longer duration of seizure freedom. Kaplan-Meier curves with log-rank test were created to visualize differences in time to seizure recurrence. Of 7504 articles identified, 18 were included for study-level analysis. iECoG was not associated with higher seizure freedom at the study level (relative risk = 1.09, 95% confidence interval [CI] = 0.96-1.23, p = .19, I = 64%), but on IPD (n = 7 studies, 231 patients) iECoG use was independently associated with more favorable seizure outcomes (hazard ratio = 0.47, 95% CI = .23-.95, p = .037). In Kaplan-Meier analysis of specific pathologies, iECoG use was significantly associated with longer seizure freedom only for focal cortical dysplasia (FCD; p < .001) etiology. Number needed to treat for iECoG was 8.8, and for iECoG in FCD it was 4.7. We show iECoG seizure freedom is not achieved uniformly across centers. iECoG is particularly beneficial for FCD etiology in improving seizure freedom.
尽管术中皮层脑电图（iECoG）在切除性癫痫手术中得到广泛应用，但关于其总体疗效以及无法根据病理情况预测获益的相关数据仍存在矛盾。鉴于iECoG在切除性癫痫手术中的使用存在异质性，评估基于发作间期的iECoG的效用很重要。这项个体患者数据（IPD）荟萃分析旨在确定iECoG在切除性癫痫手术中对各种病理类型实现无癫痫发作的益处。从数据库建立至2021年1月31日，使用以下检索词在Embase、Scopus和PubMed数据库中进行检索：“ecog”、“electrocorticography”和“epilepsy”。如果文章报告了在有或没有iECoG的癫痫手术队列中随访≥12个月时的无癫痫发作情况，则纳入研究。排除非英文文章、非对照性iECoG队列以及iECoG使用率<10%的研究。这项荟萃分析遵循PRISMA 2020指南。主要结局是最后一次随访时的无癫痫发作情况以及适用时的癫痫复发时间。采用随机效应模型的森林图评估iECoG使用与无癫痫发作之间的关系。对IPD进行Cox回归分析以确定无癫痫发作持续时间更长的预测因素。绘制带有对数秩检验的Kaplan-Meier曲线以直观显示癫痫复发时间的差异。在识别出的7504篇文章中，有18篇纳入研究水平分析。在研究水平上，iECoG与更高的无癫痫发作率无关（相对风险=1.09, 95%置信区间[CI]=0.96 - 1.23, p = 0.19, I² = 64%），但在IPD分析中（n = 7项研究，231例患者），使用iECoG与更有利的癫痫发作结局独立相关（风险比=0.47, 95% CI = 0.23 - 0.95, p = 0.037）。在对特定病理类型的Kaplan-Meier分析中，仅对于局灶性皮质发育不良（FCD）病因，使用iECoG与更长时间的无癫痫发作显著相关（p < 0.001）。iECoG的治疗所需人数为8.8，FCD中iECoG的治疗所需人数为4.7。我们发现不同中心使用iECoG实现无癫痫发作的情况并不一致。iECoG对FCD病因在改善无癫痫发作方面特别有益。
