| Objective: Frontal lobe epilepsy(FLE)is the second most common focal intractable epilepsy.There are many relevant studies about seizure outcomes and predictors of prognosis after FLE surgery,but the results are often different.This study aims to better understand the long-term outcomes and predictors of prognosis after FLE surgery,guiding the evaluation of treatment and giving patients expectations reference.Data and Methods: This study conducted a comprehensive systematic review and Meta analysis of the long-term prognosis and predictors after frontal lobe epilepsy surgery by reviewing literatures,combined with the clinical data of patients with frontal lobe epilepsy undergoing surgical treatment by multimodal epilepsy surgical evaluation system in the functional neurosurgery of the Second Hospital of Lanzhou University from January 2016 to February 2020,to analyze and study the seizure outcomes after frontal lobe epilepsy surgery and the influence of various research variables on the prognosis.Results: Our Meta-analysis showed that the overall rate of good prognosis(Engel I)was 53.2% in 22 studies of 1285 patients with frontal lobe epilepsy,and the good prognosis rate was not significantly correlated with the year of publication.The predictive factors of prognosis after FLE surgery include duration of epilepsy(SMD0.24,95%CI [0.07,0.41]),age at surgery(SMD-0.15,95%CI [-0.39,0.08]),the presence or absence of generalized tonic-clonic seizures(RR 1.16,95%CI [0.98,1.38]),preoperative MRI findings(RR 0.68,95%CI [0.57,0.82]),intracranial EEG monitoring(RR 0.69,95%CI [0.59,0.81]),surgical resection area(RR 0.76,95%CI[0.62,0.92]),the completeness of resection of focus-related frontal lobe epilepsy(RR0.45,95%CI [0.37,0.54]),focus-related frontal lobe epilepsy such as tumor and focal cerebral dysplasia compared with other pathological results(RR 0.81,95%CI [0.66,0.99]),with or without acute postoperative epileptic seizures(RR 2.16,95%CI [1.76,2.65]).The analysis of the clinical data of 30 patients with frontal lobe epilepsy in the functional neurosurgery department of the Second Hospital of Lanzhou University showed that the good prognosis rate after FLE surgery(Engel I)was 70%,and the average follow-up was(33.9±14.1)months.The results of multivariate logistic regression analysis showed that the duration of epilepsy,the frequency of seizures,the presence or absence of stereotactic EEG monitoring,whether the lesion was completely removed,and whether acute postoperative seizures occurred were independent predictors of prognosis(P<0.05).Conclusion:Although surgical treatment of refractory FLE can control seizures,its efficacy is not as good as that of temporal lobe epilepsy.There is still plenty of space for improvement.Thus,it is of great importance to improve the precision evaluation technology before epilepsy surgery.This study found that the long duration of epilepsy and postoperative acute seizures are significantly related to poor prognosis.The application of stereotactic EEG and complete resection of epileptic lesions can significantly improve the prognosis of FLE surgery. |
