Multiple subpial transection for intractable partial epilepsy: an international meta-analysis.
OBJECTIVE
Because the number and variety of patients at any single facility is not sufficient for clinical or statistical analysis, data from six major epilepsy centers that performed multiple subpial transections (MSTs) for medically intractable epilepsy were collected.


METHODS
A meta-analysis was performed to elucidate the indications and outcome, and to assess the results of the procedure. Overall, 211 patients were represented with data regarding preoperative evaluation, procedures, seizure types and frequencies before and after surgery, postoperative deficits, and demographic information. Fifty-three patients underwent MST without resection.


RESULTS
In patients with MST plus resection, excellent outcome (>95% reduction in seizure frequency) was obtained in 87% of patients for generalized seizures, 68% for complex partial seizures, and 68% for simple partial seizures. For the patients who underwent MST without resection, the rate of excellent outcome was only slightly lower, at 71% for generalized, 62% for complex partial, and 63% for simple partial seizures. EEG localization, age at epilepsy onset, duration of epilepsy, and location of MST were not significant predictors of outcome for any kinds of seizures after MST, with or without resection. New neurologic deficits were found in 47 patients overall, comparable in MST with resection (23%) or without (19%).


CONCLUSIONS
These preliminary results suggest that MST has efficacy by itself, with minimal neurologic compromise, in cases in which resective surgery cannot be used to treat uncontrolled epilepsy. MST should be investigated as a stand-alone procedure to allow further development of criteria and predictive factors for outcome.
Spencer
Susan S
SS
Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06520-8018, USA. susan.spencer@yale.edu
Schramm
Johannes
J
Wyler
Allen
A
O'Connor
Michael
M
Orbach
Darren
D
Krauss
Gregory
G
Sperling
Michael
M
Devinsky
Orrin
O
Elger
Christian
C
Lesser
Ronald
R
Mulligan
Lisa
L
Westerveld
Michael
M
D004828:Epilepsies, Partial / Q000601:surgery*; D006801:Humans; D010841:Pia Mater / Q000601:surgery*