A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia

Clinical article

Nathan C. Rowland UCSF Comprehensive Epilepsy Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D., Ph.D.
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Dario J. Englot UCSF Comprehensive Epilepsy Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D., Ph.D.
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Tene A. Cage UCSF Comprehensive Epilepsy Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D.
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Michael E. Sughrue UCSF Comprehensive Epilepsy Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D.
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Nicholas M. Barbaro UCSF Comprehensive Epilepsy Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D.
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Edward F. Chang UCSF Comprehensive Epilepsy Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D.
Page Range:
1035–1041
Volume/Issue:
Volume 116: Issue 5
DOI link:
https://doi.org/10.3171/2012.1.JNS111105
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Object

Focal cortical dysplasia (FCD) is one of the most common causes of medically refractory epilepsy leading to surgery. However, seizure control outcomes reported in isolated surgical series are highly variable. As a result, it is not clear which variables are most crucial in predicting seizure freedom following surgery for FCD. The authors' aim was to determine the prognostic factors for seizure control in FCD by performing a meta-analysis of the published literature.

Methods

A MEDLINE search of the published literature yielded 37 studies that met inclusion and exclusion criteria. Seven potential prognostic variables were determined from these studies and were dichotomized for analysis. For each variable, individual studies were weighted by inverse variance and combined to generate an odds ratio favoring seizure freedom. The methods complied with a standardized meta-analysis reporting protocol.

Results

Two thousand fourteen patients were included in the analysis. The overall rate of seizure freedom (Engel Class I) among patients undergoing surgery for FCD in the cohort of studies was 55.8% ± 16.2%. Partial seizures, a temporal location, detection with MRI, and a Type II Palmini histological classification were associated with higher rates of postoperative seizure control. As a treatment-related factor, complete resection of the anatomical or electrographic abnormality was the most important predictor overall of seizure freedom. Neither age nor electroencephalographic localization of the ictal onset significantly affected seizure freedom after surgery.

Conclusions

Using a large population cohort pooled from the published literature, an analysis identified important factors that are prognostic in patients with epilepsy due to FCD. The most important of these factors—diagnostic imaging and resection—provide modalities through which improvements in the impact of FCD can be effected.

Abbreviations used in this paper:

EEG = electroencephalography; FCD = focal cortical dysplasia.
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Contributor Notes

Address correspondence to: Edward F. Chang, M.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M-779, San Francisco, California 94143-0112. email: ChangEd@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online February 10, 2012; DOI: 10.3171/2012.1.JNS111105.

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