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Predictors of seizure recurrence in patients with surgery for focal cortical dysplasia: pairwise and network meta-analysis and trial sequential analysis

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Abstract

Object

The aim of this study was to determine the predictors of seizure recurrence in surgery for focal cortical dysplasia (FCD) by conducting a meta-analysis.

Methods

Publications that met the pre-stated inclusion criteria were selected from PubMed and CNKI databases. Two authors extracted data independently about prognostic factors, surgical outcome, and clinical characteristics of participants. A fixed-effects model was used to calculate the summary of odds ratio (OR) with 95% confidence interval (CI).

Results

Forty-eight studies were included in our meta-analysis. Three predictors of seizure recurrence (Engel class III/IV)—histological FCD type I, incomplete resection, and extratemporal location were determined; combined OR with 95% CI were 1.94 (95%CI 1.53–2.46), 12.06 (95%CI 7.32–19.88), and 1.91 (95%CI 1.06–3.44), respectively. Trial sequential analysis revealed that the outcomes had a sufficient sample size to reach firm conclusions. Furthermore, seizure location was not substantially modified by geographic region, while histological FCD type I and incomplete resection showed a significant association with seizure recurrence in different continents except Asia for incomplete resection. Sensitivity analyses restricted to studies for each variable yielded robust results. Little evidence of publication bias was observed. Meanwhile, the difference in the standard for outcome failed to influence the results for prognosis. Network meta-analysis including 13 trials comparing subtypes of FCD found the FCD IIb had the lowest seizure recurrence rate.

Conclusions

This meta-analysis suggests that histological FCD type I, incomplete resection, and extratemporal location are recurrence factors in patients with epilepsy surgery for FCD. In addition, FCD IIb is associated with the highest rates of postoperative seizure control among the subtypes of FCD, type I and type II.

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Funding

This work was supported by grants from the National Natural Science Foundation of China (No. 81771217; No.81771394).

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Authors and Affiliations

  1. Department of Neurosurgery, Chongqing University CancerHospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, China

    Jie Chen

  2. Department of Neurosurgery, General Hospital of the People’s Liberation Army Chengdu Military Region, Chengdu, 610083, Sichuan, China

    Xin Chen

  3. Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, 77030, USA

    Chen Huang

  4. Department of Internal Medicine St. Luke’s Hospital, Chesterfield, MO, 63017, USA

    He Zhu

  5. Epilepsy research center of PLA, Department of Neurosurgery, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China

    Zhi Hou, Ning An, Shi-Yong Liu, Hui Yang & Chun-Qing Zhang

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  1. Jie Chen
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Chen, J., Chen, X., Huang, C. et al. Predictors of seizure recurrence in patients with surgery for focal cortical dysplasia: pairwise and network meta-analysis and trial sequential analysis. Childs Nerv Syst 35, 753–767 (2019). https://doi.org/10.1007/s00381-019-04124-0

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