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

Harward SC, Chen WC, Rolston JD, Haglund MM, Englot DJ
Neurosurgery. 2018 82 (3): 350-358

PMID: 28419330 · PMCID: PMC5640459 · DOI:10.1093/neuros/nyx158

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.

Copyright © 2017 by the Congress of Neurological Surgeons

MeSH Terms (9)

Drug Resistant Epilepsy Electroencephalography Epilepsies, Partial Female Humans Male Seizures Treatment Outcome Vision Disorders

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