TY - JOUR
T1 - Multiple subpial transection for intractable partial epilepsy
T2 - An international meta-analysis
AU - Spencer, Susan S.
AU - Schramm, Johannes
AU - Wyler, Allen
AU - O'Connor, Michael
AU - Orbach, Darren
AU - Krauss, Gregory
AU - Sperling, Michael
AU - Devinsky, Orrin
AU - Elger, Christian
AU - Lesser, Ronald
AU - Mulligan, Lisa
AU - Westerveld, Michael
PY - 2002
Y1 - 2002
N2 - Purpose: Because the number and variety of patients at any single facility is not sufficient for clinical or statistical analysis, data from six major epilepsy centers that performed multiple subpial transections (MSTs) for medically intractable epilepsy were collected. Methods: A meta-analysis was performed to elucidate the indications and outcome, and to assess the results of the procedure. Overall, 211 patients were represented with data regarding preoperative evaluation, procedures, seizure types and frequencies before and after surgery, postoperative deficits, and demographic information. Fifty-three patients underwent MST without resection. Results: In patients with MST plus resection, excellent outcome (<95% reduction in seizure frequency) was obtained in 87% of patients for generalized seizures, 68% for complex partial seizures, and 68% for simple partial seizures. For the patients who underwent MST without resection, the rate of excellent outcome was only slightly lower, at 71% for generalized, 62% for complex partial, and 63% for simple partial seizures. EEG localization, age at epilepsy onset, duration of epilepsy, and location of MST were not significant predictors of outcome for any kinds of seizures after MST, with or without resection. New neurologic deficits were found in 47 patients overall, comparable in MST with resection (23%) or without (19%). Conclusions: These preliminary results suggest that MST has efficacy by itself, with minimal neurologic compromise, in cases in which resective surgery cannot be used to treat uncontrolled epilepsy. MST should be investigated as a stand-alone procedure to allow further development of criteria and predictive factors for outcome.
AB - Purpose: Because the number and variety of patients at any single facility is not sufficient for clinical or statistical analysis, data from six major epilepsy centers that performed multiple subpial transections (MSTs) for medically intractable epilepsy were collected. Methods: A meta-analysis was performed to elucidate the indications and outcome, and to assess the results of the procedure. Overall, 211 patients were represented with data regarding preoperative evaluation, procedures, seizure types and frequencies before and after surgery, postoperative deficits, and demographic information. Fifty-three patients underwent MST without resection. Results: In patients with MST plus resection, excellent outcome (<95% reduction in seizure frequency) was obtained in 87% of patients for generalized seizures, 68% for complex partial seizures, and 68% for simple partial seizures. For the patients who underwent MST without resection, the rate of excellent outcome was only slightly lower, at 71% for generalized, 62% for complex partial, and 63% for simple partial seizures. EEG localization, age at epilepsy onset, duration of epilepsy, and location of MST were not significant predictors of outcome for any kinds of seizures after MST, with or without resection. New neurologic deficits were found in 47 patients overall, comparable in MST with resection (23%) or without (19%). Conclusions: These preliminary results suggest that MST has efficacy by itself, with minimal neurologic compromise, in cases in which resective surgery cannot be used to treat uncontrolled epilepsy. MST should be investigated as a stand-alone procedure to allow further development of criteria and predictive factors for outcome.
KW - Epilepsy surgery
KW - MST
KW - Multiple subpial transection
KW - Refractory epilepsy
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U2 - 10.1046/j.1528-1157.2002.28101.x
DO - 10.1046/j.1528-1157.2002.28101.x
M3 - Article
C2 - 11903459
AN - SCOPUS:0036123587
SN - 0013-9580
VL - 43
SP - 141
EP - 145
JO - Epilepsia
JF - Epilepsia
IS - 2
ER -