Surgical outcomes for medically intractable epilepsy in low- and middle-income countries: A systematic review and meta-analysis

Alireza Mansouri, Shervin Taslimi, Aram Abbasian, Jetan H. Badhiwala, Muhammad Ali Akbar, Naif M. Alotaibi, Saleh A. Almenawer, Alexander G. Weil, Aria Fallah, Lionel Carmant, George M. Ibrahim

Research output: Contribution to journalReview article

Abstract

OBJECTIVE The aim of this study was to describe the current state of epilepsy surgery and establish estimates of seizure outcomes following surgery for medically intractable epilepsy (MIE) in low- and middle-income countries (LMICs). METHODS The MEDLINE and Embase databases were searched without publication date restriction. This search was supplemented by a manual screen of key epilepsy and neurosurgical journals (January 2005 to December 2016). Studies that reported outcomes for at least 10 patients of any age undergoing surgery for MIE in LMICs over a defined follow-up period were included. A meta-analysis with a random-effects model was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. Pooled estimates of seizure freedom and favorable seizure outcomes following anterior temporal lobectomy with or without amygdalohippocampectomy (ATL ± AH) were reported. RESULTS Twenty studies were selected, of which 16 were from Asian centers. The average age at surgery in all studies was less than 30 years, and the average preoperative duration of epilepsy ranged from 3 to 16.1 years. Mesial temporal sclerosis accounted for 437 of 951 described pathologies, and 1294 of the 1773 procedures were ATL ± AH. Based on 7 studies (646 patients) the pooled seizure freedom estimate following ATL ± AH was 68% (95% CI 55%–82%). Based on 8 studies (1096 patients), the pooled estimate for favorable seizure outcomes was 79% (95% CI 74%–85%). CONCLUSIONS Surgery for MIE in LMICs shows a high percentage of seizure freedom and favorable outcomes. These findings call for a concerted global effort to improve timely access to surgery for MIE patients in these regions, including investments aimed at refining existing and establishing additional centers.

Original languageEnglish (US)
Pages (from-to)1068-1078
Number of pages11
JournalJournal of neurosurgery
Volume131
Issue number4
DOIs
StatePublished - Oct 2019

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Meta-Analysis
Seizures
Epilepsy
Anterior Temporal Lobectomy
Sclerosis
MEDLINE
Observational Studies
Publications
Drug Resistant Epilepsy
Epidemiology
Outcome Assessment (Health Care)
Databases
Guidelines
Pathology

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Mansouri, Alireza ; Taslimi, Shervin ; Abbasian, Aram ; Badhiwala, Jetan H. ; Akbar, Muhammad Ali ; Alotaibi, Naif M. ; Almenawer, Saleh A. ; Weil, Alexander G. ; Fallah, Aria ; Carmant, Lionel ; Ibrahim, George M. / Surgical outcomes for medically intractable epilepsy in low- and middle-income countries : A systematic review and meta-analysis. In: Journal of neurosurgery. 2019 ; Vol. 131, No. 4. pp. 1068-1078.
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title = "Surgical outcomes for medically intractable epilepsy in low- and middle-income countries: A systematic review and meta-analysis",
abstract = "OBJECTIVE The aim of this study was to describe the current state of epilepsy surgery and establish estimates of seizure outcomes following surgery for medically intractable epilepsy (MIE) in low- and middle-income countries (LMICs). METHODS The MEDLINE and Embase databases were searched without publication date restriction. This search was supplemented by a manual screen of key epilepsy and neurosurgical journals (January 2005 to December 2016). Studies that reported outcomes for at least 10 patients of any age undergoing surgery for MIE in LMICs over a defined follow-up period were included. A meta-analysis with a random-effects model was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. Pooled estimates of seizure freedom and favorable seizure outcomes following anterior temporal lobectomy with or without amygdalohippocampectomy (ATL ± AH) were reported. RESULTS Twenty studies were selected, of which 16 were from Asian centers. The average age at surgery in all studies was less than 30 years, and the average preoperative duration of epilepsy ranged from 3 to 16.1 years. Mesial temporal sclerosis accounted for 437 of 951 described pathologies, and 1294 of the 1773 procedures were ATL ± AH. Based on 7 studies (646 patients) the pooled seizure freedom estimate following ATL ± AH was 68{\%} (95{\%} CI 55{\%}–82{\%}). Based on 8 studies (1096 patients), the pooled estimate for favorable seizure outcomes was 79{\%} (95{\%} CI 74{\%}–85{\%}). CONCLUSIONS Surgery for MIE in LMICs shows a high percentage of seizure freedom and favorable outcomes. These findings call for a concerted global effort to improve timely access to surgery for MIE patients in these regions, including investments aimed at refining existing and establishing additional centers.",
author = "Alireza Mansouri and Shervin Taslimi and Aram Abbasian and Badhiwala, {Jetan H.} and Akbar, {Muhammad Ali} and Alotaibi, {Naif M.} and Almenawer, {Saleh A.} and Weil, {Alexander G.} and Aria Fallah and Lionel Carmant and Ibrahim, {George M.}",
year = "2019",
month = "10",
doi = "10.3171/2018.5.JNS18599",
language = "English (US)",
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Mansouri, A, Taslimi, S, Abbasian, A, Badhiwala, JH, Akbar, MA, Alotaibi, NM, Almenawer, SA, Weil, AG, Fallah, A, Carmant, L & Ibrahim, GM 2019, 'Surgical outcomes for medically intractable epilepsy in low- and middle-income countries: A systematic review and meta-analysis', Journal of neurosurgery, vol. 131, no. 4, pp. 1068-1078. https://doi.org/10.3171/2018.5.JNS18599

Surgical outcomes for medically intractable epilepsy in low- and middle-income countries : A systematic review and meta-analysis. / Mansouri, Alireza; Taslimi, Shervin; Abbasian, Aram; Badhiwala, Jetan H.; Akbar, Muhammad Ali; Alotaibi, Naif M.; Almenawer, Saleh A.; Weil, Alexander G.; Fallah, Aria; Carmant, Lionel; Ibrahim, George M.

In: Journal of neurosurgery, Vol. 131, No. 4, 10.2019, p. 1068-1078.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Surgical outcomes for medically intractable epilepsy in low- and middle-income countries

T2 - A systematic review and meta-analysis

AU - Mansouri, Alireza

AU - Taslimi, Shervin

AU - Abbasian, Aram

AU - Badhiwala, Jetan H.

AU - Akbar, Muhammad Ali

AU - Alotaibi, Naif M.

AU - Almenawer, Saleh A.

AU - Weil, Alexander G.

AU - Fallah, Aria

AU - Carmant, Lionel

AU - Ibrahim, George M.

PY - 2019/10

Y1 - 2019/10

N2 - OBJECTIVE The aim of this study was to describe the current state of epilepsy surgery and establish estimates of seizure outcomes following surgery for medically intractable epilepsy (MIE) in low- and middle-income countries (LMICs). METHODS The MEDLINE and Embase databases were searched without publication date restriction. This search was supplemented by a manual screen of key epilepsy and neurosurgical journals (January 2005 to December 2016). Studies that reported outcomes for at least 10 patients of any age undergoing surgery for MIE in LMICs over a defined follow-up period were included. A meta-analysis with a random-effects model was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. Pooled estimates of seizure freedom and favorable seizure outcomes following anterior temporal lobectomy with or without amygdalohippocampectomy (ATL ± AH) were reported. RESULTS Twenty studies were selected, of which 16 were from Asian centers. The average age at surgery in all studies was less than 30 years, and the average preoperative duration of epilepsy ranged from 3 to 16.1 years. Mesial temporal sclerosis accounted for 437 of 951 described pathologies, and 1294 of the 1773 procedures were ATL ± AH. Based on 7 studies (646 patients) the pooled seizure freedom estimate following ATL ± AH was 68% (95% CI 55%–82%). Based on 8 studies (1096 patients), the pooled estimate for favorable seizure outcomes was 79% (95% CI 74%–85%). CONCLUSIONS Surgery for MIE in LMICs shows a high percentage of seizure freedom and favorable outcomes. These findings call for a concerted global effort to improve timely access to surgery for MIE patients in these regions, including investments aimed at refining existing and establishing additional centers.

AB - OBJECTIVE The aim of this study was to describe the current state of epilepsy surgery and establish estimates of seizure outcomes following surgery for medically intractable epilepsy (MIE) in low- and middle-income countries (LMICs). METHODS The MEDLINE and Embase databases were searched without publication date restriction. This search was supplemented by a manual screen of key epilepsy and neurosurgical journals (January 2005 to December 2016). Studies that reported outcomes for at least 10 patients of any age undergoing surgery for MIE in LMICs over a defined follow-up period were included. A meta-analysis with a random-effects model was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. Pooled estimates of seizure freedom and favorable seizure outcomes following anterior temporal lobectomy with or without amygdalohippocampectomy (ATL ± AH) were reported. RESULTS Twenty studies were selected, of which 16 were from Asian centers. The average age at surgery in all studies was less than 30 years, and the average preoperative duration of epilepsy ranged from 3 to 16.1 years. Mesial temporal sclerosis accounted for 437 of 951 described pathologies, and 1294 of the 1773 procedures were ATL ± AH. Based on 7 studies (646 patients) the pooled seizure freedom estimate following ATL ± AH was 68% (95% CI 55%–82%). Based on 8 studies (1096 patients), the pooled estimate for favorable seizure outcomes was 79% (95% CI 74%–85%). CONCLUSIONS Surgery for MIE in LMICs shows a high percentage of seizure freedom and favorable outcomes. These findings call for a concerted global effort to improve timely access to surgery for MIE patients in these regions, including investments aimed at refining existing and establishing additional centers.

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