Long‐term seizure outcome of surgery versus no surgery for drug‐resistant partial epilepsy: A review of controlled studies

Open Access
Publisher Website
Google Scholar
Abstract
A majority of patients with formerly drug‐resistant temporal lobe epilepsy become seizure‐free after surgery. However, apart from one 12‐month randomized trial, it is unclear how many become seizure‐free because of surgery. To determine the net benefit of surgery, we performed a systematic review and meta‐analysis of the published evidence of how many patients in similar studies become seizure‐free without surgery. Of 155 potentially eligible articles reviewed in full text, 29 (19%) fulfilled eligibility criteria. After excluding 9 publications, 20 studies form the base of evidence. Overall, 719 of 1,621 (44%) of patients with mostly temporal lobe surgery were seizure‐free compared to 139 of 1113 (12%) of nonoperated controls [pooled random effects relative risk (RR) 4.26, 95% confidence interval (CI) 3.03–5.98]. The pooled risk difference in favor of surgery was 42% (95% CI 32–51%). We found no comparative outcome data in patients with extratemporal lobe epilepsy only. The available evidence from mostly nonrandomized observational studies indicates that in appropriately selected patients with drug‐resistant temporal lobe epilepsy, the combination of surgery with medical treatment is 4 times as likely as medical treatment alone to achieve freedom from seizures.