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http://hdl.handle.net/11375/13087
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DC Field | Value | Language |
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dc.contributor.advisor | Bhandari, Mohit | en_US |
dc.contributor.advisor | Guyatt, Gordon | en_US |
dc.contributor.advisor | Walter, Stephen | en_US |
dc.contributor.author | Fallah, Aria | en_US |
dc.date.accessioned | 2014-06-18T17:02:20Z | - |
dc.date.available | 2014-06-18T17:02:20Z | - |
dc.date.created | 2013-07-02 | en_US |
dc.date.issued | 2013-10 | en_US |
dc.identifier.other | opendissertations/7915 | en_US |
dc.identifier.other | 8957 | en_US |
dc.identifier.other | 4283371 | en_US |
dc.identifier.uri | http://hdl.handle.net/11375/13087 | - |
dc.description.abstract | <p><strong>Objective</strong>: To perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex (TSC) undergoing resective epilepsy surgery.</p> <p><strong>Data sources</strong>: Electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions.</p> <p><strong>Study selection:</strong> We included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate.</p> <p><strong>Data extraction</strong>: One author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes.</p> <p><strong>Data synthesis</strong>: To identify predictors of a good seizure outcome (i.e. Engel Class I or II) we used logistic regression adjusting for length of follow-up for each preoperative variable.</p> <p><strong>Results</strong>: Of 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69%) participants (Engel Class I: 102(56%); Engel class II: 24(13%)). On univariable analysis, absence of generalized seizure semiology (OR=3.1, 95%CI=1.2-8.2, p=0.022), no or mild developmental delay (OR=7.3, 95%CI=2.1-24.7, p=0.001), unifocal ictal scalp electroencephalographic (EEG) abnormality (OR=3.2, 95%CI=1.4-7.6, p=0.008) and EEG/Magnetic resonance imaging concordance (OR=4.9, 95%CI=1.8-13.5, p=0.002) were associated with a good postoperative seizure outcome.</p> <p><strong>Conclusions</strong>: Small retrospective cohort studies are inherently prone to bias, some of which are overcome using individual participant data. The best evidence suggests 4 preoperative factors predictive of good seizure outcomes following resective epilepsy surgery. Given the low incidence of children with TSC undergoing epilepsy surgery, large long-term prospective multicenter observational studies are required to further evaluate the predictive factors identified in this review.</p> | en_US |
dc.subject | tuberious sclerosis | en_US |
dc.subject | epilepsy | en_US |
dc.subject | pediatric | en_US |
dc.subject | surgery | en_US |
dc.subject | outcomes | en_US |
dc.subject | meta-analysis | en_US |
dc.subject | Nervous System Diseases | en_US |
dc.subject | Neurology | en_US |
dc.subject | Pediatrics | en_US |
dc.subject | Nervous System Diseases | en_US |
dc.title | PREDICTORS OF SEIZURE OUTCOMES IN CHILDREN WITH TUBEROUS SCLEROSIS COMPLEX UNDERGOING RESECTION EPILEPSY SURGERY: AN INDIVIDUAL PARTICIPANT DATA META-ANALYSIS | en_US |
dc.type | thesis | en_US |
dc.contributor.department | Clinical Health Sciences (Health Research Methodology) | en_US |
dc.description.degree | Master of Science (MSc) | en_US |
Appears in Collections: | Open Access Dissertations and Theses |
Files in This Item:
File | Description | Size | Format | |
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fulltext.pdf | 624.56 kB | Adobe PDF | View/Open | |
MSc_Thesis___Title_2.0.docx | 28.29 kB | Microsoft Word XML | View/Open |
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