title: Multiple subpial transection for intractable partial epilepsy: an international meta-analysis.
abstract: 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.
authors.affiliation: Department of Neurology, Yale University School of Medicine, New Haven, Connecticut 06520-8018, USA. susan.spencer@yale.edu
authors.forename: Susan S
authors.initials: SS
authors.lastname: Spencer
authors.forename: Johannes
authors.initials: J
authors.lastname: Schramm
authors.forename: Allen
authors.initials: A
authors.lastname: Wyler
authors.forename: Michael
authors.initials: M
authors.lastname: O'Connor
authors.forename: Darren
authors.initials: D
authors.lastname: Orbach
authors.forename: Gregory
authors.initials: G
authors.lastname: Krauss
authors.forename: Michael
authors.initials: M
authors.lastname: Sperling
authors.forename: Orrin
authors.initials: O
authors.lastname: Devinsky
authors.forename: Christian
authors.initials: C
authors.lastname: Elger
authors.forename: Ronald
authors.initials: R
authors.lastname: Lesser
authors.forename: Lisa
authors.initials: L
authors.lastname: Mulligan
authors.forename: Michael
authors.initials: M
authors.lastname: Westerveld
mesh_terms: D004828:Epilepsies, Partial / Q000601:surgery*; D006801:Humans; D010841:Pia Mater / Q000601:surgery*