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The influence of disease course and surgery on quality of life in children with focal cortical dysplasia and long-term epilepsy-associated tumours: A systematic review and meta-analysis

Vasilica, AM; Winsor, A; Chari, A; Scott, R; Baldeweg, T; Tisdall, M; (2023) The influence of disease course and surgery on quality of life in children with focal cortical dysplasia and long-term epilepsy-associated tumours: A systematic review and meta-analysis. Epilepsy Research , 192 , Article 107132. 10.1016/j.eplepsyres.2023.107132. (In press). Green open access

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Abstract

Introduction: Carefully selected patients with lesional epilepsy, including focal cortical dysplasia (FCD) and long-term epilepsy-associated tumours (LEAT), can benefit from epilepsy surgery. The influence of disease course and subsequent epilepsy surgery on quality of life (QoL) and intelligence quotient (IQ) is not well understood. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting QoL or IQ measures in paediatric patients with FCD and LEAT at epilepsy onset, at establishment of drug resistance (pre-operative/non-surgically managed) and post-operatively were included. To evaluate the “effect size” and clinical significance of surgery, a meta-analysis of the data was conducted using fixed effects models for weighted mean differences, 95% confidence intervals and sensitivity analyses. Results: Nineteen eligible studies (911 patients) were included, 17 assessing IQ and 2 evaluating QoL. Twelve studies reported preoperative and postoperative IQ measures and five reported IQ in non-surgically managed cohorts after drug resistance was established; no papers reported IQ at epilepsy onset. No significant IQ/DQ changes were detected after surgery (pre-operative pooled mean 69.32; post-operative pooled mean 69.98; p = 0.32). Age at epilepsy surgery, type of surgery and epilepsy-related pathology did not influence the post-operative IQ. QoL was reported in 2 studies with the pooled mean estimates for pre- and post-operative QoL being 42.52 and 55.50, respectively. Conclusions: The present study demonstrated no statistical change in IQ and QoL following surgery in paediatric patients with FCD and LEAT. There was no data on IQ and QoL at disease onset. Attempting to understand the impact of epilepsy, ongoing seizures and surgery on IQ and QoL will facilitate planning of future studies that aim to optimise quality of life and developmental outcomes in these children. Studies assessing children at epilepsy onset with longitudinal follow-up are required to optimise the timing of epilepsy surgery on QoL and IQ.

Type: Article
Title: The influence of disease course and surgery on quality of life in children with focal cortical dysplasia and long-term epilepsy-associated tumours: A systematic review and meta-analysis
Location: Netherlands
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.eplepsyres.2023.107132
Publisher version: https://doi.org/10.1016/j.eplepsyres.2023.107132
Language: English
Additional information: © 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)
Keywords: Epilepsy, Focal cortical dysplasia, IQ, Lesion-associated epilepsy tumours, Quality of life, Surgery
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Neurosciences Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10168463
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