Seizure outcomes in children with Sturge-Weber syndrome undergoing epilepsy surgery: An individual participant data meta-analysis

Authors

Khashayar Mozaffari, School of Medicine and Health Sciences, The George Washington University, Washington, DC, United States.
Asha Krishnakumar, School of Medicine, Virginia Commonwealth University, Richmond, United States.
Jia-Shu Chen, Warren Alpert Medical School of Brown University, Providence, United States.
Keshav Goel, David Geffen School of Medicine at University of California, Los Angeles, United States.
Andrew Wang, David Geffen School of Medicine at University of California, Los Angeles, United States.
Nathan A. Shlobin, Northwestern University Feinberg School of Medicine, Chicago, United States.
Alexander G. Weil, Department of Surgery, Division of Neurosurgery, Ste. Justine University Hospital, University of Montreal, Quebec, Canada; Department of Neuroscience, University of Montreal, Quebec, Canada; Division of Neurosurgery, Ste. Justine Hospital, University of Montreal, Quebec, Canada.
Aria Fallah, Department of Neurosurgery and Pediatrics, Los Angeles (UCLA), University of California, 300 Stein Plaza Driveway, Suite 525, Los Angeles, CA 90095, United States. Electronic address: Afallah@mednet.ucla.edu.

Document Type

Journal Article

Publication Date

3-15-2023

Journal

Seizure

Volume

107

DOI

10.1016/j.seizure.2023.03.008

Keywords

Epilepsy outcome; Hemispheric surgery; Individual participant data meta-analysis; Resection; Sturge-Weber syndrome

Abstract

BACKGROUND: A subpopulation of patients with Sturge-Weber syndrome (SWS) develop medically intractable epilepsy. There is a paucity of literature on preoperative factors that predict postoperative seizure outcomes in these patients. An individual participant data meta-analysis (IPDMA) was performed to discern preoperative variables associated with favorable seizure outcomes in pediatric SWS patients undergoing epilepsy surgery. METHODS: PubMed, Cochrane, Web of Science, and Scopus were independently queried following PRISMA guidelines. Studies that reported seizure outcomes in individual pediatric SWS patients were selected. Preoperative demographic variables and disease characteristics were recorded and evaluated in a time-to-event fashion via Cox regression and Kaplan-Meier analysis with log-rank test. RESULTS: A total of 18 studies with 108 patients were included for meta-analysis. Median age at seizure onset was 4.5 months, and 85 patients (78.7%) were seizure-free at last follow-up (median: 72 months). On multivariable Cox regression, no variables were independent predictors of post-operative seizure freedom duration, including the extent of hemispheric resection. There were also no differences in time-to-seizure recurrence on Kaplan-Meier analysis when comparing those treated with hemispheric surgery and those with less than hemispheric surgery (p = 0.52). CONCLUSION: This IPDMA showed that both resective and hemispheric epilepsy surgery achieve favorable and comparable seizure outcomes in pediatric SWS patients. The best available evidence using IPD suggests that resective surgery may be an appropriate alternative to hemispheric epilepsy surgery in well-selected patients. Prospective multi-institutional studies with greater follow-up are warranted to further investigate predictors of seizure outcome in pediatric SWS patients.

APA Citation

Mozaffari, Khashayar; Krishnakumar, Asha; Chen, Jia-Shu; Goel, Keshav; Wang, Andrew; Shlobin, Nathan A.; Weil, Alexander G.; and Fallah, Aria, "Seizure outcomes in children with Sturge-Weber syndrome undergoing epilepsy surgery: An individual participant data meta-analysis" (2023). GW Authored Works. Paper 2583.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2583

Department

School of Medicine and Health Sciences Student Works