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Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis.

Publication ,  Journal Article
Harward, SC; Chen, WC; Rolston, JD; Haglund, MM; Englot, DJ
Published in: Neurosurgery
March 1, 2018

BACKGROUND: Occipital lobe epilepsy (OLE) is an uncommon but debilitating focal epilepsy syndrome with seizures often refractory to medical management. While surgical resection has proven a viable treatment, previous studies examining postoperative seizure freedom rates are limited by small sample size and patient heterogeneity, thus exhibiting significant variability in their results. OBJECTIVE: To review the medical literature on OLE so as to investigate rates and predictors of both seizure freedom and visual outcomes following surgery. METHODS: We reviewed manuscripts exploring surgical resection for drug-resistant OLE published between January 1990 and June 2015 on PubMed. Seizure freedom rates were analyzed and potential predictors were evaluated with separate meta-analyses. Postoperative visual outcomes were also examined. RESULTS: We identified 27 case series comprising 584 patients with greater than 1 yr of follow-up. Postoperative seizure freedom (Engel class I outcome) was observed in 65% of patients, and was significantly predicted by age less than 18 yr (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.13-2.18), focal lesion on pathological analysis (OR 2.08, 95% CI 1.58-2.89), and abnormal preoperative magnetic resonance imaging (OR 3.24, 95% 2.03-6.55). Of these patients, 175 also had visual outcomes reported with 57% demonstrating some degree of visual decline following surgery. We did not find any relationship between postoperative visual and seizure outcomes. CONCLUSION: Surgical resection for OLE is associated with favorable outcomes with nearly two-thirds of patients achieving postoperative seizure freedom. However, patients must be counseled regarding the risk of visual decline following surgery.

Duke Scholars

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

March 1, 2018

Volume

82

Issue

3

Start / End Page

350 / 358

Location

United States

Related Subject Headings

  • Vision Disorders
  • Treatment Outcome
  • Seizures
  • Neurology & Neurosurgery
  • Male
  • Humans
  • Female
  • Epilepsies, Partial
  • Electroencephalography
  • Drug Resistant Epilepsy
 

Citation

APA
Chicago
ICMJE
MLA
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Harward, S. C., Chen, W. C., Rolston, J. D., Haglund, M. M., & Englot, D. J. (2018). Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis. Neurosurgery, 82(3), 350–358. https://doi.org/10.1093/neuros/nyx158
Harward, Stephen C., William C. Chen, John D. Rolston, Michael M. Haglund, and Dario J. Englot. “Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis.Neurosurgery 82, no. 3 (March 1, 2018): 350–58. https://doi.org/10.1093/neuros/nyx158.
Harward SC, Chen WC, Rolston JD, Haglund MM, Englot DJ. Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis. Neurosurgery. 2018 Mar 1;82(3):350–8.
Harward, Stephen C., et al. “Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis.Neurosurgery, vol. 82, no. 3, Mar. 2018, pp. 350–58. Pubmed, doi:10.1093/neuros/nyx158.
Harward SC, Chen WC, Rolston JD, Haglund MM, Englot DJ. Seizure Outcomes in Occipital Lobe and Posterior Quadrant Epilepsy Surgery: A Systematic Review and Meta-Analysis. Neurosurgery. 2018 Mar 1;82(3):350–358.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

March 1, 2018

Volume

82

Issue

3

Start / End Page

350 / 358

Location

United States

Related Subject Headings

  • Vision Disorders
  • Treatment Outcome
  • Seizures
  • Neurology & Neurosurgery
  • Male
  • Humans
  • Female
  • Epilepsies, Partial
  • Electroencephalography
  • Drug Resistant Epilepsy