Surgical Management in Patients With Drug-Resistant Epilepsy: A Summary of Four Systematic Reviews and Meta-Analyses.
11 affiliations
- 1McMaster University, Hamilton, ON, Canada.
- 2Geisel School of Medicine at Dartmouth and Dartmouth Health, Lebanon, NH, USA.
- 3Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- 4George Washington University, Washington, DC, USA.
- 5University of Chicago, Chicago, IL, USA.
- 6American Epilepsy Society, Chicago, IL, USA.
- 7Rush University, Chicago, IL, USA.
- 8Epilepsy Center, Cleveland Clinic, Cleveland, Ohio, USA.
- 9University of Maryland School of Medicine, Baltimore, MD, USA.
- 10University of Pittsburgh, Pittsburgh, PA, USA.
- 11Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Abstract
Drug-resistant epilepsy (DRE) may lead to substantial morbidity, impaired quality of life (QoL), and increased mortality. Clinicians increasingly use surgical interventions to manage DRE, but uncertainty remains regarding their comparative benefits and harms across epilepsy syndromes. We conducted 4 systematic reviews and meta-analyses to inform the American Epilepsy Society (AES) and Congress of Neurological Surgeons (CNS) guidelines on surgical management of DRE. We searched MEDLINE, Embase, and CENTRAL from inception to August 2024 for randomized controlled trials (RCTs) and nonrandomized studies (NRS). We evaluated (1) resective or ablative surgery versus medical therapy in drug-resistant mesiotemporal lobe epilepsy (DR-MTLE); (2) resective or ablative surgery versus medical therapy in drug-resistant neocortical epilepsy (DR-NE); (3) callosotomy versus vagus nerve stimulation (VNS) in developmental and epileptic encephalopathies (DEEs) with drop attacks; and (4) ablative versus resective surgery in hypothalamic hamartoma (HH). The panel prioritized the following critical outcomes: seizure freedom, QoL, neuropsychological, neuropsychiatric, and social outcomes, and serious adverse events. We assessed certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. We included 59 studies comprising 4868 participants. In DR-MTLE, moderate-certainty evidence from RCTs showed that anterior temporal lobectomy (ATL), compared with medical therapy, probably increases seizure freedom and improves QoL. The evidence was very uncertain regarding the effects of selective amygdalohippocampectomy, laser interstitial thermal therapy (LITT), and radiosurgery in patients with DRE. In DR-NE, very low-certainty evidence suggested that seizure freedom may occur after resective surgery. However, we did not identify any eligible studies evaluating ablative surgery in this population. In DEE, very low-certainty evidence suggested that, when compared to VNS, callosotomy may improve seizure outcomes but may also increase serious adverse events. In HH, evidence for LITT and radiosurgery was found to be very uncertain. Across reviews, the most common reason for downgrading the certainty of evidence was risk of bias and imprecision. Moderate-certainty evidence supports ATL in selected patients with DR-MTLE. For other surgical approaches and epilepsy syndromes, the evidence remains very uncertain, highlighting the need for better comparative studies.
Related
- Current Evidence of Rehabilitation for Patients with Drug-resistant Epilepsy: Systematic Review and Meta-analysis
- Epilepsy Surgery vs Medical Management for Pediatric Drug-Resistant Focal Epilepsy
- Status of presurgical evaluation among patients with drug-resistant epilepsy identified with a computable electronic health record algorithm
- The impact of comorbid headache on surgical outcomes in drug-resistant focal epilepsy
- How to Implement a Ketogenic Diet Therapy in Developing Countries: Colombian Consensus on Ketogenic Diet Therapy Use in the Management of Adults with Drug-Resistant Epilepsy
BibTeX
@article{roldan2026surgical,
title = {{Surgical Management in Patients With Drug-Resistant Epilepsy: A Summary of Four Systematic Reviews and Meta-Analyses.}},
author = {Yetiani Roldan and Barbara C Jobst and Daniela Garcia-Aquino and Dina Ghandour and Mei Bou Nasif and Taylor Duda and Alexandra Eid and Shannon Hart and Mohamad Kesserwan and Amanda Martyniuk and Melissa Lannon and Golbarg Saber and Christopher Saouda and Sunjay Sharma and Victoria Vinarsky and Shawna L Strickland and Robyn M Busch and Jennifer L Hopp and Jorge Gonzalez-Martinez and Gregory Bergey and Andrea J Darzi},
journal = {Epilepsy currents},
year = {2026},
month = jul,
doi = {10.1177/15357597261459808},
url = {https://europepmc.org/article/MED/42923082},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Surgical Management in Patients With Drug-Resistant Epilepsy: A Summary of Four Systematic Reviews and Meta-Analyses.
AU - Yetiani Roldan
AU - Barbara C Jobst
AU - Daniela Garcia-Aquino
AU - Dina Ghandour
AU - Mei Bou Nasif
AU - Taylor Duda
AU - Alexandra Eid
AU - Shannon Hart
AU - Mohamad Kesserwan
AU - Amanda Martyniuk
AU - Melissa Lannon
AU - Golbarg Saber
AU - Christopher Saouda
AU - Sunjay Sharma
AU - Victoria Vinarsky
AU - Shawna L Strickland
AU - Robyn M Busch
AU - Jennifer L Hopp
AU - Jorge Gonzalez-Martinez
AU - Gregory Bergey
AU - Andrea J Darzi
PY - 2026
DA - 2026/07/13
JO - Epilepsy currents
DO - 10.1177/15357597261459808
UR - https://europepmc.org/article/MED/42923082
AB - Drug-resistant epilepsy (DRE) may lead to substantial morbidity, impaired quality of life (QoL), and increased mortality. Clinicians increasingly use surgical interventions to manage DRE, but uncertainty remains regarding their comparative benefits and harms across epilepsy syndromes. We conducted 4 systematic reviews and meta-analyses to inform the American Epilepsy Society (AES) and Congress of Neurological Surgeons (CNS) guidelines on surgical management of DRE. We searched MEDLINE, Embase, and CENTRAL from inception to August 2024 for randomized controlled trials (RCTs) and nonrandomized studies (NRS). We evaluated (1) resective or ablative surgery versus medical therapy in drug-resistant mesiotemporal lobe epilepsy (DR-MTLE); (2) resective or ablative surgery versus medical therapy in drug-resistant neocortical epilepsy (DR-NE); (3) callosotomy versus vagus nerve stimulation (VNS) in developmental and epileptic encephalopathies (DEEs) with drop attacks; and (4) ablative versus resective surgery in hypothalamic hamartoma (HH). The panel prioritized the following critical outcomes: seizure freedom, QoL, neuropsychological, neuropsychiatric, and social outcomes, and serious adverse events. We assessed certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. We included 59 studies comprising 4868 participants. In DR-MTLE, moderate-certainty evidence from RCTs showed that anterior temporal lobectomy (ATL), compared with medical therapy, probably increases seizure freedom and improves QoL. The evidence was very uncertain regarding the effects of selective amygdalohippocampectomy, laser interstitial thermal therapy (LITT), and radiosurgery in patients with DRE. In DR-NE, very low-certainty evidence suggested that seizure freedom may occur after resective surgery. However, we did not identify any eligible studies evaluating ablative surgery in this population. In DEE, very low-certainty evidence suggested that, when compared to VNS, callosotomy may improve seizure outcomes but may also increase serious adverse events. In HH, evidence for LITT and radiosurgery was found to be very uncertain. Across reviews, the most common reason for downgrading the certainty of evidence was risk of bias and imprecision. Moderate-certainty evidence supports ATL in selected patients with DR-MTLE. For other surgical approaches and epilepsy syndromes, the evidence remains very uncertain, highlighting the need for better comparative studies.
SN - 1535-7597
SN - 1535-7511
ER -