Department of Neurology, Baylor College of Medicine, Houston, Texas, USA.
Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
J Neurotrauma. 2024 Feb;41(3-4):319-330. doi: 10.1089/neu.2023.0084. Epub 2023 Oct 20.
Epilepsy surgery provides excellent benefits in post-traumatic epilepsy of the temporal lobe (PTE-TL), but outcomes relative to non-traumatic epilepsy of the temporal lobe (NTE-TL) are less favorable. Large well-designed studies are recommended to further clarify the role of epilepsy surgery in PTE. It is unclear whether epilepsy surgery outcomes in PTE are as robust as described for drug resistant epilepsy (DRE) in general. Prior outcome studies in PTE are limited by small numbers, lack of a control group, or both. We performed a meta-analysis of studies in temporal lobe epilepsy (TLE) to evaluate post-surgical outcomes in those with PTE-TL and compare outcomes to those with NTE-TL. PubMed, EMBASE, and Web of Science databases were queried for studies reporting epilepsy surgery outcomes separately for PTE-TL and NTE-TL. Outcomes were divided into favorable (Engel Class I) or unfavorable (Engel Class II-IV) for comparison. Meta-analyses were performed to evaluate: 1) the proportion of Class I outcomes following epilepsy surgery in PTE-TL; and 2) calculate the odds of Class I surgical outcomes in PTE-TL compared with NTE-TL. Of 3669 articles that reported surgical outcomes in epilepsy, nine studies ( = 886) were identified that reported outcomes for both PTE-TL ( = 219) and NTE-TL ( = 667). The weighted proportion of favorable outcomes (Engel Class I) were high for both PTE-TL (70.1%, 95% CI 61.9%-78.3%) and NTE-TL (75.2%, 95% CI 69.4%-80.2%). Patients with PTE-TL were at greater risk of unfavorable (Engel Class II-IV) outcomes (relative risk 1.36, 95% CI 1.04-1.78) compared with NTE-TL.
癫痫手术在颞叶创伤后癫痫(PTE-TL)中提供了极好的益处,但与非创伤性颞叶癫痫(NTE-TL)相比,结果不太理想。建议进行大型设计良好的研究,以进一步阐明癫痫手术在 PTE 中的作用。目前尚不清楚 PTE 中癫痫手术的结果是否与一般耐药性癫痫(DRE)所描述的那样稳健。以前的 PTE 结果研究受到数量少、缺乏对照组或两者兼有的限制。我们对颞叶癫痫(TLE)的研究进行了荟萃分析,以评估 PTE-TL 患者手术后的结果,并将结果与 NTE-TL 患者进行比较。在 PubMed、EMBASE 和 Web of Science 数据库中查询了分别报告 PTE-TL 和 NTE-TL 癫痫手术结果的研究。结果分为有利(Engel Ⅰ级)或不利(Engel Ⅱ-Ⅳ级)进行比较。进行荟萃分析以评估:1)PTE-TL 癫痫手术后Ⅰ级结果的比例;2)与 NTE-TL 相比,PTE-TL 中Ⅰ级手术结果的可能性。在报告癫痫手术结果的 3669 篇文章中,确定了 9 项研究( = 886),这些研究报告了 PTE-TL( = 219)和 NTE-TL( = 667)的结果。PTE-TL(70.1%,95%CI 61.9%-78.3%)和 NTE-TL(75.2%,95%CI 69.4%-80.2%)的有利结局(Engel Ⅰ级)的加权比例均很高。与 NTE-TL 相比,PTE-TL 患者发生不良结局(Engel Ⅱ-Ⅳ级)的风险更高(相对风险 1.36,95%CI 1.04-1.78)。
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