Seizure outcomes after resection of temporal encephalocele in patients with drug‐resistant epilepsy: A systematic review and meta‐analysis
Bibliographic record
Abstract
OBJECTIVE: Temporal encephaloceles (TEs) are seen in patients with drug-resistant epilepsy (DRE); yet they are also common incidental findings. Variability in institutional pre-surgical epilepsy practices and interpretation of epileptogenic network localization contributes to bias in existing epilepsy cohorts with TE, and therefore the relevance of TE in DRE remains controversial. We sought to estimate effect sizes and sample sizes necessary to demonstrate clinically relevant improvements in seizure outcome with different surgical approaches. METHODS: We searched Medline, Embase, and Cochrane to identify studies reporting the outcomes of epilepsy surgery after 12 months in patients with DRE and TE. The main outcome was seizure freedom or favorable seizure outcome. We also assessed the rates of seizure freedom among patients with DRE, TE, and the following covariables: use of intracranial electroencephalography (iEEG), side of the encephalocele, sex, and type of surgical resection (anterior temporal lobectomy [ATL] vs lesionectomy). Random-effects meta-analysis was used to calculate the proportion of patients attaining seizure outcomes. RESULTS: We identified 332 studies, of which 15 (282 patients) met inclusion criteria for meta-analysis. Seizure-freedom rate was 65% (95% confidence interval [CI] 53-76), whereas the favorable outcome rate was 78% (95% CI 70-85). There was no significant interstudy heterogeneity. Patients with TE undergoing iEEG (risk ratio [RR] 0.80, 95% CI 0.74-0.87) had a lower chance of a favorable seizure outcome. A power analysis estimated a sample size of 28 932 patients with TE (13 764 with ATL) necessary to determine a significant difference in seizure freedom between limited resection and ATL. SIGNIFICANCE: Retrospective cohort studies demonstrate good outcomes after TE resection regardless of the extent of resection. Prohibitively large sample sizes necessary to observe outcome differences between surgical approaches and presurgical predictors indicate that improved biomarkers and mechanistic understanding of TE epileptogenicity are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.022 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.034 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".