Systematic Review and Network Meta-analysis of Resective Surgery for Mesial Temporal Lobe Epilepsy
Abstract number :
1.221
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2018
Submission ID :
495558
Source :
www.aesnet.org
Presentation date :
12/1/2018 6:00:00 PM
Published date :
Nov 5, 2018, 18:00 PM
Authors :
Puneet Jain, The Hospital for Sick Children; George Tomlinson, Toronto Health Economics and Technology Assessment (THETA), University Health Network; Carter Snead, The Hospital for Sick Children; Beate Sander, Institute of Health Policy, Management and Ev
Rationale: To evaluate the effectiveness of anterior temporal lobectomy (ATL) vs. selective amygdalohippocampectomy (SAH) on seizure-free outcome in patients with temporal lobe epilepsy (TLE), utilizing both direct and indirect evidence from the literature. Methods: MEDLINE, Embase and Cochrane databases were searched for original research articles and systematic reviews comparing ATL vs. SAH, ATL or SAH vs. medical management (MM). The outcome was seizure freedom at 12 months follow-up or longer. Direct pairwise meta-analyses were conducted, followed by a random-effect Bayesian network meta-analysis (NMA) combining direct and indirect evidence. Results: Twenty-eight articles were included (18 compared ATL vs. SAH, 1 compared ATL vs. SAH vs. MM, 8 compared ATL vs. MM, and 1 compared SAH vs. MM). Direct pairwise meta-analyses showed no significant differences in seizure-free outcome of ATL vs. SAH (odds ratio (OR) 1.14, 95% Confidence interval (CI) 0.93–1.39; p = 0.201), but the odds of seizure-free outcome was higher for ATL vs. MM (OR 29.16, 95% CI 10.44–81.50; p0.05). Conclusions: Direct evidence, indirect evidence and NMA did not identify a difference in seizure-free outcome of ATL vs. SAH. Funding: None