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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

PREDICTORS OF SEIZURE OUTCOMES IN CHILDREN WITH TUBEROUS SCLEROSIS COMPLEX UNDERGOING RESECTION EPILEPSY SURGERY: AN INDIVIDUAL PARTICIPANT DATA META-ANALYSIS

Fallah, Aria 10 1900 (has links)
<p><strong>Objective</strong>: To perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex (TSC) undergoing resective epilepsy surgery.</p> <p><strong>Data sources</strong>: Electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions.</p> <p><strong>Study selection:</strong> We included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate.</p> <p><strong>Data extraction</strong>: One author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes.</p> <p><strong>Data synthesis</strong>: To identify predictors of a good seizure outcome (i.e. Engel Class I or II) we used logistic regression adjusting for length of follow-up for each preoperative variable.</p> <p><strong>Results</strong>: Of 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69%) participants (Engel Class I: 102(56%); Engel class II: 24(13%)). On univariable analysis, absence of generalized seizure semiology (OR=3.1, 95%CI=1.2-8.2, p=0.022), no or mild developmental delay (OR=7.3, 95%CI=2.1-24.7, p=0.001), unifocal ictal scalp electroencephalographic (EEG) abnormality (OR=3.2, 95%CI=1.4-7.6, p=0.008) and EEG/Magnetic resonance imaging concordance (OR=4.9, 95%CI=1.8-13.5, p=0.002) were associated with a good postoperative seizure outcome.</p> <p><strong>Conclusions</strong>: Small retrospective cohort studies are inherently prone to bias, some of which are overcome using individual participant data. The best evidence suggests 4 preoperative factors predictive of good seizure outcomes following resective epilepsy surgery. Given the low incidence of children with TSC undergoing epilepsy surgery, large long-term prospective multicenter observational studies are required to further evaluate the predictive factors identified in this review.</p> / Master of Science (MSc)

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