Evidence map›Paper›PMID 28637175›Full record

SynthesisNeurosurgery2018

Multiple Subpial Transections for Medically Refractory Epilepsy: A Disaggregated Review of Patient-Level Data.

John D Rolston, Hansen Deng, Doris D Wang, Dario J Englot, Edward F Chang

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Neurosurgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
2.0field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 30 citations in OpenAlex.

  1. Pooled it
  2. Subpial transection surgery for epilepsy.The Cochrane database of systematic reviews · 2018
    Pooled it
  3. Review
  4. Review
  5. Article
  6. Review
  7. Review
  8. Review
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

John D RolstonDepartment of Neurological Surgery, University of California, San Francisco, California.
Hansen DengSchool of Medicine, University of California, San Francisco, California.
Doris D WangDepartment of Neurological Surgery, University of California, San Francisco, California.
Dario J EnglotDepartment of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Edward F ChangDepartment of Neurological Surgery, University of California, San Francisco, California.
Neurological Surgery · USVanderbilt University Medical Center · USUniversity of California, San Francisco · US

Funding

MULTIMODAL MAPPING OF SUBCORTICAL AND CORTICAL FUNCTIONAL NETWORK DISTURBANCES IN FOCAL EPILEPSYR00NS097618 · NINDS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI ENGLOT, DARIO J · 2017 to 2019
$743k
MULTIMODAL MAPPING OF SUBCORTICAL AND CORTICAL FUNCTIONAL NETWORK DISTURBANCES IN FOCAL EPILEPSYK99NS097618 · NINDS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI ENGLOT, DARIO J · 2016 to 2016
$83k
NINDS NIH HHS K99 NS097618NINDS NIH HHS R00 NS097618
6 · The paper itself

Abstract

backgroundMultiple subpial transections (MST) are a treatment for seizure foci in nonresectable eloquent areas.

objectiveTo systematically review patient-level data regarding MST.

methodsStudies describing patient-level data for MST procedures were extracted from the Medline and PubMed databases, yielding a synthetic cohort of 212 patients from 34 studies. Data regarding seizure outcome, patient demographics, seizure type, surgery type, and complications were extracted and analyzed.

resultsSeizure freedom was achieved in 55.2% of patients undergoing MST combined with resection, and 23.9% of patients undergoing MST alone. Significant predictors for seizure freedom were a temporal lobe focus (odds ratio 4.9; 95% confidence interval 1.71, 14.3) and resection of portions of the focus, when feasible (odds ratio 3.88; 95% confidence interval 2.02, 7.45). Complications were frequent, with transient mono- or hemiparesis affecting 19.8% of patients, transient dysphasia 12.3%, and permanent paresis or dysphasia in 6.6% and 1.9% of patients, respectively.

conclusionMST is an effective treatment for refractory epilepsy in eloquent cortex, with greater chances of seizure freedom when portions of the focus are resected in tandem with MST. The reported rates of seizure freedom with MST are higher than those of existing neuromodulatory therapies, such as vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation, though these latter therapies are supported by randomized-controlled trials, while MST is not. The reported complication rate of MST is higher than that of resection and neuromodulatory therapies. MST remains a viable option for the treatment of eloquent foci, provided a careful risk-benefit analysis is conducted.

Indexed as

AdolescentAdultChildDrug Resistant EpilepsyFemaleHumansMaleMiddle AgedNeurosurgical ProceduresTreatment Outcome

Identifiers

PMID28637175
PMCPMC5738293
OpenAlexW2697248426

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.