Sensorimotor outcomes after resection for perirolandic drug-resistant epilepsy: a systematic review and individual patient data meta-analysis

Author:

Shlobin Nathan A.1,Wang Andrew2,Phillips H. Westley2,Yan Han3,Ibrahim George M.3,Elkaim Lior M.4,Wang Shuang5,Liu Xiaoyan5,Cai Lixin5,Nguyen Dang K.678,Fallah Aria2,Weil Alexander G.9810

Affiliation:

1. Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;

2. Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, California;

3. Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario;

4. Division of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada;

5. Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China;

6. Division of Neurology, University of Montreal Hospital Centre (CHUM), Montreal;

7. CHUM Research Centre, Montreal;

8. Department of Neuroscience, University of Montreal; and

9. Division of Neurosurgery, Sainte-Justine University Hospital and University of Montreal Hospital Centre (CHUM), Montreal;

10. Sainte-Justine Research Centre, University of Montreal, Quebec, Canada

Abstract

OBJECTIVE The prevalence of long-term postoperative sensorimotor deficits in children undergoing perirolandic resective epilepsy surgery is unclear. The risk of developing these deficits must be weighed against the potential reduction in seizure frequency after surgery. In this study, the authors investigated the prevalence of sensorimotor deficits after resective surgery at ≥ 1 year postoperatively. METHODS A systematic review and individual patient data meta-analysis was conducted using PubMed, Embase, and Scopus databases. Subgroups of patients were identified and categorized according to their outcomes as follows: group A patients were denoted as seizure free with no postoperative sensorimotor deficits; group B patients experienced seizure recurrence with no deficit; group C patients were seizure free with deficits; and group D patients were not seizure free and with deficits. Rates of sensory deficits were examined in patients undergoing postcentral gyrus resection, and rates of motor deficits were aggregated in patients undergoing precentral gyrus resection. RESULTS Of 797 articles resulting from the database searches, 6 articles including 164 pediatric patients at a mean age of 7.7 ± 5.2 years with resection for drug-resistant perirolandic epilepsy were included in the study. Seizure freedom was observed in 118 (72.9%) patients at a mean follow-up of 3.4 ± 1.8 years. In total, 109 (66.5%) patients did not develop sensorimotor deficits at last follow-up, while 55 (33.5%) had permanent deficits. Ten (14.3%) of 70 patients with postcentral gyrus resection had permanent sensory deficits. Of the postcentral gyrus resection patients, 41 (58.6%) patients were included in group A, 19 (27.1%) in group B, 7 (10.0%) in group C, and 3 (4.3%) in group D. Forty (37.7%) of 106 patients with precentral resections had permanent motor deficits. Of the precentral gyrus resection patients, 50 (47.2%) patients were in group A, 16 (15.1%) in group B, 24 (22.6%) in group C, and 16 (15.1%) in group D. Patients without focal cortical dysplasia were more likely to have permanent motor deficits relative to those with focal cortical dysplasia in the precentral surgery cohort (p = 0.02). CONCLUSIONS In total, 58.6% of patients were seizure free without deficit, 27.1% were not seizure free and without deficit, 10.0% were seizure free but with deficit, and 4.3% were not seizure free and with deficit. Future studies with functional and quality-of-life data, particularly for patients who experience seizure recurrence with no deficits (as in group B in the present study) and those who are seizure free with deficits (as in group C) after treatment, are necessary to guide surgical decision-making.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

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