Clinical outcomes and quality of life following surgical treatment for refractory epilepsy: a systematic review and meta-analysis

Shi-Yong Liu, Xiao-Lin Yang, Bing Chen, Zhi Hou, Ning An, Mei-Hua Yang, Hui Yang, Shi-Yong Liu, Xiao-Lin Yang, Bing Chen, Zhi Hou, Ning An, Mei-Hua Yang, Hui Yang

Abstract

Surgery for refractory epilepsy is widely used but the efficacy of this treatment for providing a seizure-free outcome and better quality of life remains unclear.This study aimed to update current evidence and to evaluate the effects of surgery on quality of life in patients with refractory epilepsy.A systematic review and meta-analysis of the literature were conducted and selected studies included 2 groups of refractory epilepsy patients, surgical and nonsurgical.The studies were assessed using the Newcastle-Ottawa Scale. The primary outcome was the seizure-free rate. The secondary outcome was quality of life. Adverse events were also reviewed.After screening, a total of 20 studies were selected: 8 were interventional, including 2 randomized controlled trials, and 12 were observational. All of the studies comprised 1959 patients with refractory epilepsy. The seizure-free rates were significantly higher for patients who received surgery compared with the patients who did not; the combined odds ratio was 19.35 (95% CI = 12.10-30.95, P < 0.001). After adjusting for publication bias the combined odds ratio was 10.25 (95% CI = 5.84-18.00). In both the interventional and observational studies, patients treated surgically had a significantly better quality of life compared with the patients not treated surgically. Complications were listed in 3 studies and the rates were similar in surgical and nonsurgical patients.Our meta-analysis found that for patients with refractory epilepsy, surgical treatment appears to provide a much greater likelihood of seizure-free outcome than nonsurgical treatment, although there is a need for more studies, particularly randomized studies, to confirm this conclusion. Based on more limited data, surgical treatment also appeared to provide a better quality of life and did not seem to increase complications.

Conflict of interest statement

The authors have no and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow chart of study selection.
FIGURE 2
FIGURE 2
Meta-analysis for seizure-free rate of patients with refractory epilepsy compared between surgical and nonsurgical treatments (all studies, interventional, observational).
FIGURE 3
FIGURE 3
Meta-analysis for quality of life of patients with refractory epilepsy compared between surgical and nonsurgical treatments: (A) interventional (B) observational.
FIGURE 4
FIGURE 4
Sensitivity analysis for treatment effects on seizure-free rate by leave-one-out approach: (A) all studies, (B) interventional, (C) observational.
FIGURE 5
FIGURE 5
Sensitivity analysis for treatment effects on quality of life by leave-one-out approach: (A) interventional, (B) observational.
FIGURE 6
FIGURE 6
Funnel plots for evaluating publication bias regarding seizure-free rate for all studies (A, B), interventional studies (C, D), and observational studies (E, F). White circles represent observed studies, and black circles represent possibly missed studies imputed using Duval and Tweedie trim-and-fill method. White and black rhombuses represent observed and theoretical combined effect size, respectively.

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