Surgical versus medical treatment of drug-resistant epilepsy: A systematic review and meta-analysis.
Epilepsy Behav
; 82: 179-188, 2018 05.
Article
em En
| MEDLINE
| ID: mdl-29576434
ABSTRACT
OBJECTIVE:
Surgery and drug therapy are the two main treatments for refractory epilepsy. However, to date, there has not been an adequate comparison of the outcomes of these two treatments. This systematic review compared the overall outcome of surgery and medical treatment in patients with drug-resistant epilepsy.METHODS:
Articles published in Embase, Medline, Pubmed, and the Cochrane library were searched from their inception until June 2016.RESULTS:
Twenty of the eighty-one (24.7%) full-text articles reviewed fulfilled the eligibility criteria and were included in the meta-analysis. Of 1800 patients with drug-resistant epilepsy, 526 of 923 patients (57.0%) in the surgery group were seizure-free compared with 134 of 877 patients (15.3%) in the medical treatment group (19 studies, risk ratio (RR)=3.72, 95% confidence interval (CI) [2.75-5.03]; P<0.00001, I2=53%). In addition, more patients were off antiepileptic drugs (AEDs) in the surgical group (3 studies, n=438, RR=4.76, 95% CI [2.21, 10.28], P<0.0001, I2=0%). Although different studies used different questionnaires to assess patient quality of life (QOL) in both treatment groups, the overall postintervention QOL scores were higher in the surgery than in the medical treatment group, by SMD (6 studies, n=459, SMD=0.61, 95% CI [0.23, 0.98], P=0.002, I2=66%).CONCLUSION:
As the complications of interventions, declines in memory, and word recall/naming were not assessed in the meta-analysis, the conclusions are limited to seizure-free, AED use, and QOL. The current evidence indicate that compared with medical treatment, surgery is more likely to achieve seizure-free, off AEDs, and better QOL.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Encéfalo
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Epilepsia Resistente a Medicamentos
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Anticonvulsivantes
Tipo de estudo:
Etiology_studies
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Risk_factors_studies
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Systematic_reviews
Limite:
Humans
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article