Abstract
Background
Nearly 30% of patients with epilepsy continue to have seizures in spite of using several antiepileptic drug (AED) regimens. Such patients are regarded as having refractory, or uncontrolled, epilepsy. No definition of uncontrolled, or medically refractory, epilepsy has been universally accepted, but for the purposes of this review, we will consider seizures as drug resistant if they have failed to respond to a minimum of two AEDs. It is believed that early surgical intervention may prevent seizures at a younger age, which, in turn, may improve the intellectual and social status of children. Many types of surgery are available for treatment of refractory epilepsy; one such procedure is known as subpial transection.
Objectives
To determine the benefits and adverse effects of subpial transection for partial-onset seizures and generalised tonic-clonic seizures in children and adults.
Search methods
We searched the Cochrane Epilepsy Group Specialised Register (29 June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; May 2015, Issue 5) and MEDLINE (1946 to 29 June 2015). We imposed no language restrictions.
Selection criteria
We considered all randomised and quasi-randomised parallel-group studies, whether blinded or non-blinded.
Data collection and analysis
Two review authors (BK and SR) independently screened trials identified by the search. The same two review authors planned to independently assess the methodological quality of studies. When studies were identified for inclusion, one review author would have extracted the data, and the other would have verified the data.
Main results
We found no relevant studies.
Authors’ conclusions
We found no evidence to support or refute use of subpial transection surgery for patients with medically refractory epilepsy. Well-designed randomised controlled trials are needed to guide clinical practice.
Plain language summary
Subpial transection surgery for epilepsy
Nearly 30% of patients with epilepsy continue to have seizures despite taking several antiepileptic drugs (AEDs). Such patients are regarded as having refractory, or uncontrolled, epilepsy. Uncontrolled epilepsy by itself directly affects the intellectual function and social status of children. It causes considerable morbidity and mortality, affecting the person’s quality of life. Some people with refractory epilepsy benefit from surgical treatment. Multiple subpial transection (MST) is a surgical technique by which connections of the epileptic focus are partially cut without resection. MST is one type of surgery that can be performed for people with medically refractory epilepsy, for whom the epileptogenic zone cannot be resected because of high risk of neurological deficits. In this review, we planned to assess benefits and adverse effects of multiple subpial transection in patients with refractory epilepsy. We found no randomised controlled trials comparing subpial transection versus antiepileptic drug therapy or subpial transection versus another type of epilepsy surgery. Therefore, evidence is insufficient for assessment of benefits or adverse effects of subpial transection; additional studies are needed.
