Outcome of emergency neurosurgery in patients with refractory and super-refractory status epilepticus: a systematic review and individual participant data meta-analysis.

Autor:	Niazi F; Department of Medicine, Université de Montréal, Montreal, QC, Canada.; Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada., Han A; Department of Medicine, Université de Montréal, Montreal, QC, Canada.; Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada., Stamm L; Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada.; Department of Medicine, McGill University, Montreal, QC, Canada., Shlobin NA; Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States., Korman C; Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada.; Department of Medicine, McGill University, Montreal, QC, Canada., Hoang TS; Department of Health Sciences, Université de Montréal, Montreal, QC, Canada., Kielian A; Department of Neurology, Boston Children's Hospital, Boston, MA, United States.; Harvard Medical School, Boston, MA, United States., Du Pont-Thibodeau G; Division of Pediatric Intensive Care, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada., Ducharme Crevier L; Division of Pediatric Intensive Care, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada., Major P; Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada.; Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada.; Department of Neuroscience, Université de Montréal, Montreal, QC, Canada., Nguyen DK; Department of Neuroscience, Université de Montréal, Montreal, QC, Canada.; Division of Neurology, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada., Bouthillier A; Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada., Ibrahim GM; Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada.; Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada., Fallah A; Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States., Hadjinicolaou A; Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada.; Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC, Canada.; Department of Neuroscience, Université de Montréal, Montreal, QC, Canada., Weil AG; Brain and Development Research Axis, CHU Sainte-Justine Research Centre, Montreal, QC, Canada.; Department of Neuroscience, Université de Montréal, Montreal, QC, Canada.; Division of Neurosurgery, Department of Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC, Canada.; Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Centre, Montreal, QC, Canada.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2024 May 28; Vol. 15, pp. 1403266. Date of Electronic Publication: 2024 May 28 (Print Publication: 2024).
DOI:	10.3389/fneur.2024.1403266
Abstrakt:	Background: Refractory (RSE) and super-refractory status epilepticus (SRSE) are serious neurological conditions requiring aggressive management. Beyond anesthetic agents, there is a lack of evidence guiding management in these patients. This systematic review and individual participant data meta-analysis (IPDMA) seeks to evaluate and compare the currently available surgical techniques for the acute treatment of RSE and SRSE. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Individual Participant Data (PRISMA-IPD). Only patients who underwent surgery while in RSE and SRSE were included. Descriptive statistics were used to compare various subgroups. Multivariable logistic regression models were constructed to identify predictors of status epilepticus (SE) cessation, long-term overall seizure freedom, and favorable functional outcome (i.e., modified Rankin score of 0-2) at last follow-up. Results: A total of 87 studies including 161 participants were included. Resective surgery tended to achieve better SE cessation rate (93.9%) compared to non-resective techniques (83.9%), but this did not reach significance ( p  = 0.071). Resective techniques were also more likely to achieve seizure freedom (69.1% vs. 34.4%, p  = <0.0001). Older age at SE (OR = 1.384[1.046-1.832], p  = 0.023) was associated with increased likelihood of SE cessation, while longer duration of SE (OR = 0.603[0.362-1.003], p  = 0.051) and new-onset seizures (OR = 0.244[0.069-0.860], p  = 0.028) were associated with lower likelihood of SE cessation, but this did not reach significance for SE duration. Only shorter duration of SE prior to surgery (OR = 1.675[1.168-2.404], p   = 0.0060) and immediate termination of SE (OR = 3.736 [1.323-10.548], p  = 0.014) were independently associated with long-term seizure status. Rates of favorable functional outcomes (mRS of 0-2) were comparable between resective (44.4%) and non-resective (44.1%) techniques, and no independent predictors of outcome were identified. Conclusion: Our findings suggest that emergency neurosurgery may be a safe and effective alternative in patients with RSE/SRSE and may be considered earlier during the disease course. However, the current literature is limited exclusively to small case series and case reports with high risk of publication bias. Larger clinical trials assessing long-term seizure and functional outcomes are warranted to establish robust management guidelines. Competing Interests: AF serves on the board for Pediatric Epilepsy Surgery Alliance. GI serves on the advisory board of Synergia Medical. AW is a consultant for Monteris and serves on the advisory board of Synergia Medical. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor SS declared a shared affiliation with the author NS at the time of review. (Copyright © 2024 Niazi, Han, Stamm, Shlobin, Korman, Hoang, Kielian, Du Pont-Thibodeau, Ducharme Crevier, Major, Nguyen, Bouthillier, Ibrahim, Fallah, Hadjinicolaou and Weil.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu