Neurology. 2021 Dec 10; doi: 10.1212/WNL.0000000000013066. Epub 2021 Dec 10.
Seizure Outcome After Surgery for MRI-Diagnosed Focal Cortical Dysplasia: A Systematic Review and Meta-analysis.
Neurology
Anna Willard, Ana Antonic-Baker, Zhibin Chen, Terence John O'Brien, Patrick Kwan, Piero Perucca
Affiliations
Affiliations
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia.
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia.
- Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia [email protected].
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, VIC, Australia.
- Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, VIC, Australia.
PMID: 34893558
DOI: 10.1212/WNL.0000000000013066
Abstract
OBJECTIVE: Focal cortical dysplasia (FCD) has been associated with poorer post-surgical seizure outcomes compared to other pathologies. FCD surgical series have been assembled on the basis of a histological diagnosis, including patients with abnormal as well as normal pre-operative MRI. However, in clinical workflow, patient selection for surgery is based on pre-operative findings, including MRI. We performed a systematic review and meta-analysis of the literature to determine the rate and predictors of favorable seizure outcome after surgery for MRI-detected FCD.
METHODS: We devised our study protocol in accordance with PRISMA guidelines and registered the protocol with PROSPERO. We searched MEDLINE, EMBASE, and Web of Science for studies of patients followed for ≥12 months after resective surgery for drug-resistant epilepsy with MRI-detected FCD. Random-effects meta-analysis was used to calculate the proportion of patients attaining a favorable outcome, defined as Engel Class I, ILAE Classes 1-2, or "seizure-free" status. Meta-regression was performed to investigate sources of heterogeneity.
RESULTS: Our search identified 3,745 references. Of these, 35 studies (total of 1,353 patients) were included. Most studies (89%) followed patients for ≥24 months post-surgery. The overall post-surgical favorable outcome rate was 70% (95% CI: 64-75). There was high inter-study heterogeneity. Favorable outcome was associated with complete resection of the FCD lesion [risk ratio, RR=2.42 (95% CI: 1.55-3.76), p<0.001] and location of the FCD lesion in the temporal lobe [RR=1.38 (95% CI: 1.07-1.79), p=0013], but not lesion extent, intracranial EEG use, or FCD histological type. The number of FCD histological types included in the same study accounted for 7.6% of the observed heterogeneity.
CONCLUSIONS: 70% of patients with drug-resistant epilepsy and MRI features of FCD attain a favorable seizure outcome following resective surgery. Our findings can be incorporated in routine pre-operative counselling and reinforce the importance of resecting completely the MRI-detected FCD where this is safe and feasible.
© 2021 American Academy of Neurology.
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