Most studies included both children and adults, while 4 cohorts comprised only children and adolescents up to the age of 18 years, 17, 31, 32, 34 and 5 only adults. 6, 17, 21, 25, 29, 30 Age range, sex ratio, study period, and follow-up time varied across the studies. Several cohorts comprised only epileptogenic lesions. Some studies included only temporal lobe resections, 14, 17, 21, –, 23, 26, 27, 33 frontal lobe resections, 32 posterior resections, 16, 24, 31 or all extratemporal resections, 19 while other studies included resections regardless of the location. Most studies were retrospective analyses of patient data from national or local databases or medical records. For details, we refer to the extracted study data (appendix e-2, doi.org/10.5061/dryad.g8c0vm8). In total, the studies included data from 3,746 patients with drug-resistant epilepsy who had undergone resective surgery. Publications in peer-reviewed journals published in 2000 or later. English, Swedish, Norwegian, or Danish language. Randomized controlled trials (RCT) or observational studies with prospective or retrospective design. Studies that only reported mean or median duration of epilepsy for patients grouped by seizure outcome were not included. 12 Seizure freedom should be assessed at the earliest 12 months after surgery (an exception was made if a small minority of the study population was assessed earlier). Furthermore, seizure freedom should be reported as ILAE Class I (seizure-free without aura), ILAE Class I + II (seizure-free with or without aura), 11 Engel Class Ia (seizure-free), or Engel Class I (no disabling seizures). (1) Postsurgical seizure outcome expressed as proportions of patients with seizure freedom grouped by various presurgical epilepsy durations or regression analysis or other measure of association between presurgical epilepsy duration and postsurgical seizure freedom (reported as odds ratio, risk ratio, hazard ratio) (2) surgery-related complications related to presurgical epilepsy duration. Resective epilepsy surgery performed at different time intervals after epilepsy onset. Individuals with drug-resistant epilepsy at all ages, study population ≥30. The criteria for eligibility were the following: The systematic review was conducted in accordance with the PRISMA statement, 10 following an a priori but unpublished protocol available on request. Main selection criteria and methods of analysis for the review were specified and documented in advance. The review was part of a larger project investigating the effect, safety, cost-effectiveness, and ethical aspects of several methods for treatment and diagnosis of epilepsy, conducted at the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), and initiated in collaboration with the National Board of Health and Welfare. The aim of this study was therefore to assess the evidence comparing the effect of earlier or later resective epilepsy surgery on seizure outcome after surgery in a systematic review and meta-analysis. However, the study designs vary, the cohorts are often limited, and varying resection types have been studied. If corroborated, this finding further underscores the importance of early referral. 9 A number of observational studies have suggested that a short duration of epilepsy is associated with better seizure outcome after resective epilepsy surgery. 8 Many patients who are offered surgery have had drug-resistant epilepsy for half of their lives. 1, 2, 5, 6 Although the importance of early referral has been emphasized repeatedly, 7 epilepsy surgery is still considered by many neurologists to be the last resort. 4 This definition facilitates for nonspecialists to recognize patients with drug-resistant epilepsy and refer them promptly to specialist centers for evaluation of epilepsy surgery or other specialized treatments.ĭespite this, referral patterns have not undergone any major changes over the last decades. 1, –, 3 Drug resistance is defined by the Task Force of the International League Against Epilepsy (ILAE) Commission on Therapeutic Strategies as failure of adequate trials of 2 tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained seizure freedom. #Types of seizures and durations trial#Glossary GRADE = Grading of Recommendations Assessment, Development, and Evaluation ILAE = International League Against Epilepsy RCT = randomized controlled trial RD = risk difference RR = risk ratio SBU = Swedish Agency for Health Technology Assessment and Assessment of Social ServicesĮpilepsy surgery is an evidence-based treatment option for people with drug-resistant epilepsy.
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