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April 30, 2013; 80 (18) Article

Systematic review and meta-analysis of standard vs selective temporal lobe epilepsy surgery

Colin B. Josephson, Jonathan Dykeman, Kirsten M. Fiest, Xiaorong Liu, R. Mark Sadler, Nathalie Jette, Samuel Wiebe
First published April 3, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182904f82
Colin B. Josephson
From the Department of Medicine (C.B.J., R.M.S.), Division of Neurology, Dalhousie University, Halifax; Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.D., K.M.F., N.J., S.W.) and Department of Community Health Sciences and Institute of Public Health (N.J., S.W.), University of Calgary, Canada; and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China (X.L.), Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Jonathan Dykeman
From the Department of Medicine (C.B.J., R.M.S.), Division of Neurology, Dalhousie University, Halifax; Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.D., K.M.F., N.J., S.W.) and Department of Community Health Sciences and Institute of Public Health (N.J., S.W.), University of Calgary, Canada; and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China (X.L.), Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Kirsten M. Fiest
From the Department of Medicine (C.B.J., R.M.S.), Division of Neurology, Dalhousie University, Halifax; Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.D., K.M.F., N.J., S.W.) and Department of Community Health Sciences and Institute of Public Health (N.J., S.W.), University of Calgary, Canada; and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China (X.L.), Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Xiaorong Liu
From the Department of Medicine (C.B.J., R.M.S.), Division of Neurology, Dalhousie University, Halifax; Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.D., K.M.F., N.J., S.W.) and Department of Community Health Sciences and Institute of Public Health (N.J., S.W.), University of Calgary, Canada; and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China (X.L.), Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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R. Mark Sadler
From the Department of Medicine (C.B.J., R.M.S.), Division of Neurology, Dalhousie University, Halifax; Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.D., K.M.F., N.J., S.W.) and Department of Community Health Sciences and Institute of Public Health (N.J., S.W.), University of Calgary, Canada; and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China (X.L.), Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Nathalie Jette
From the Department of Medicine (C.B.J., R.M.S.), Division of Neurology, Dalhousie University, Halifax; Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.D., K.M.F., N.J., S.W.) and Department of Community Health Sciences and Institute of Public Health (N.J., S.W.), University of Calgary, Canada; and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China (X.L.), Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Samuel Wiebe
From the Department of Medicine (C.B.J., R.M.S.), Division of Neurology, Dalhousie University, Halifax; Department of Clinical Neurosciences and Hotchkiss Brain Institute (J.D., K.M.F., N.J., S.W.) and Department of Community Health Sciences and Institute of Public Health (N.J., S.W.), University of Calgary, Canada; and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China (X.L.), Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Citation
Systematic review and meta-analysis of standard vs selective temporal lobe epilepsy surgery
Colin B. Josephson, Jonathan Dykeman, Kirsten M. Fiest, Xiaorong Liu, R. Mark Sadler, Nathalie Jette, Samuel Wiebe
Neurology Apr 2013, 80 (18) 1669-1676; DOI: 10.1212/WNL.0b013e3182904f82

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Abstract

Objective: To compare standard anterior temporal lobectomy (ATL) with selective amygdalohippocampectomy (SAH) for postoperative seizure control in temporal lobe epilepsy (TLE).

Methods: We searched MEDLINE and Embase using Medical Subject Headings and keywords related to ATL and SAH. We included original research that directly compared seizure outcomes in patients undergoing SAH or ATL for TLE. A fixed-effect model was used to derive a pooled risk ratio (RR) for either an Engel Class I (free of disabling seizures) or a composite of an Engel Class I and II (rare disabling seizures) outcome.

Results: Of 4,675 abstracts initially identified by the search, 65 were reviewed as full text. Thirteen studies containing data from 8 countries (5 continents) met our inclusion criteria. Eleven studies comprising 1,203 patients demonstrated that participants were statistically more likely to achieve an Engel Class I outcome after ATL compared with SAH (risk ratio 1.32, 95% confidence interval [CI] 1.12–1.57; p < 0.01). The summary risk difference of 8% (95% CI 3%–14%) translates to a number needed to treat of 13 (95% CI 7–33) for 1 additional patient to achieve an Engel Class I outcome after ATL. The result remained significant when 2 studies that contained fewer than 15 participants in at least 1 arm were excluded and in analyses restricted to hippocampal sclerosis.

Conclusions: Standard ATL confers an improved chance of achieving freedom from disabling seizures in patients with TLE. Improved seizure freedom must be balanced against the neuropsychological impact of each procedure. A randomized controlled trial is justified.

GLOSSARY

AED=
antiepileptic drug;
ATL=
anterior temporal lobectomy;
CI=
confidence interval;
MTLE=
mesial temporal lobe epilepsy;
NNT=
number needed to treat;
RCT=
randomized controlled trial;
RR=
risk ratio;
SAH=
selective amygdalohippocampectomy;
TLE=
temporal lobe epilepsy

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 1630

  • Supplemental data at www.neurology.org

  • Received September 27, 2012.
  • Accepted in final form January 2, 2013.
  • © 2013 American Academy of Neurology
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