影响额叶癫痫手术预后预测因素的Meta分析

AMeta-analysis of predictors of prognosis after frontal lobe epilepsy surgery

目的了解额叶癫痫术后长期发作结局和影响预后的预测因素,指导评估治疗并给予患者期望参考。方法通过全面系统回顾和Meta分析探究难治性额叶癫痫术后发作结局和影响预后的预测因素。结果在22项研究1285例患者中,预后良好(EngelⅠ级)的总体比率为53.2%,预后良好率与发表年份无显著相关性,影响预后的预测因素包括癫痫病程(SMD=0.24,95%CI:[0.07,0.41])、手术年龄(SMD=0.15,95%CI:[0.39,0.08])、有无全身强直阵挛发作(RR=1.16,95%CI:[0.98,1.38])、术前磁共振成像表现(RR=0.68,95%CI:[0.57,0.82])、颅内脑电图监测情况(RR=0.69,95%CI:[0.59,0.81])、手术切除区域(RR=0.76,95%CI:[0.62,0.92])、病灶相关额叶癫痫的切除完整性(RR=0.45,95%CI:[0.37,0.54])、肿瘤和皮质发育不良等病灶相关额叶癫痫对比其他病理结果(RR=0.81,95%CI:[0.66,0.99])、有无术后急性癫痫发作(RR=2.16,95%CI:[1.76,2.65])。结论癫痫病程长、继发全身强直阵挛发作和出现术后急性癫痫发作,容易导致预后不良,而诊断明确后尽早手术、术前磁共振成像异常、颅内脑电图监测、前额叶和背外侧局限性切除、病灶的完全切除以及肿瘤和皮质发育不良等病灶相关癫痫更易获得良好预后,尽管手术可以治疗难治性额叶癫痫,但提高致痫区的精准定位对于改善预后至关重要。

Objective A better understanding of the long-term outcomes and predictors of prognosis after the frontal lobe epilepsy(FLE)surgery,in order to guide the evaluation of treatment and give patients'expectations reference.Methods A comprehensive systematic review and Meta-analysis were made to investigate into the long-term prognosis and predictors after refractory FLE resection.Results Among 1285 patients in 22 studies,the overall rate of good prognosis(EngelⅠ)was 53.2%,and the rate had no significant correlation with the year of publication.Predictors affecting the prognosis included the duration of epilepsy(SMD=0.24,95%CI:[0.07,0.41]),age at surgery(SMD=0.15,95%CI:[0.39,0.08]),the presence or absence of generalized tonic-clonic seizure(GTCS)(RR=1.16,95%CI:[0.98,1.38]),preoperative magnetic resonance imag-ing(MRI)results(RR=0.68,95%CI:[0.57,0.82]),intracranial electroencephalogram(EEG)monitoring(RR=0.69,95%CI:[0.59,0.81]),resection area(RR=0.76,95%CI:[0.62,0.92]),complete resection of lesion-related FLE(RR=0.45,95%CI:[0.37,0.54]),tumor and focal cortical dysplasia(FCD)compared with other pathological results(RR=0.81,95%CI:[0.66,0.99]),with or without postoperative acute seizures(APOS)(RR=2.16,95%CI:[1.76,2.65]).Conclusion Epilepsy with a long duration,secondary GTCS and APOS tended to have a poor prognosis,while early surgery after diagnosis,preoperative MRI abnormalities,intracranial EEG monitoring,localized resection of the prefrontal and dorsolateral,complete resection of lesions and epilepsy associated with tumors and FCD were more likely to achieve a good prognosis.These findings indicate that although surgery can treat refractory FLE,accurate localization of the epileptogenic region is critical to improving prognosis.