Incidence and Prevalence of Drug-Resistant Epilepsy

Neurology ◽  
2021 ◽  
Vol 96 (17) ◽  
pp. 805-817
Author(s):  
Bushra Sultana ◽  
Marie-Andrée Panzini ◽  
Ariane Veilleux Carpentier ◽  
Jacynthe Comtois ◽  
Bastien Rioux ◽  
...  
Keyword(s):  
Random Effects ◽  
Observational Studies ◽  
Focal Epilepsy ◽  
Meta Analysis ◽  
Drug Resistant ◽  
Eligibility Criteria ◽  
Random Effects Models ◽  
Arcsine Transformation ◽  
Drug Resistant Epilepsy ◽  
Meta Analyses

ObjectiveTo evaluate the incidence and prevalence of drug-resistant epilepsy (DRE) as well as its predictors and correlates, we conducted a systematic review and meta-analysis of observational studies.MethodsOur protocol was registered with PROSPERO, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology reporting standards were followed. We searched MEDLINE, Embase, and Web of Science. We used a double arcsine transformation and random-effects models to perform our meta-analyses. We performed random-effects meta-regressions using study-level data.ResultsOur search strategy identified 10,794 abstracts. Of these, 103 articles met our eligibility criteria. There was high interstudy heterogeneity and risk of bias. The cumulative incidence of DRE was 25.0% (95% confidence interval [CI]: 16.8–34.3) in child studies but 14.6% (95% CI: 8.8–21.6) in adult/mixed age studies. The prevalence of DRE was 13.7% (95% CI: 9.2–19.0) in population/community-based populations but 36.3% (95% CI: 30.4–42.4) in clinic-based cohorts. Meta-regression confirmed that the prevalence of DRE was higher in clinic-based populations and in focal epilepsy. Multiple predictors and correlates of DRE were identified. The most reported of these were having a neurologic deficit, an abnormal EEG, and symptomatic epilepsy. The most reported genetic predictors of DRE were polymorphisms of the ABCB1 gene.ConclusionsOur observations provide a basis for estimating the incidence and prevalence of DRE, which vary between populations. We identified numerous putative DRE predictors and correlates. These findings are important to plan epilepsy services, including epilepsy surgery, a crucial treatment option for people with disabling seizures and DRE.

scholarly journals Prognostic Role of Matrix Metalloproteinases in Cervical Cancer: A Meta-Analysis

2021 ◽  
Vol 28 ◽  
pp. 107327482110337
Author(s):  
Weiwei Chen ◽  
Shenjiao Huang ◽  
Kun Shi ◽  
Lisha Yi ◽  
Yaqiong Liu ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Matrix Metalloproteinases ◽  
Random Effects ◽  
Fixed Effects ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Free Survival ◽  
Random Effects Models ◽  
Registration Number ◽  
Meta Analyses

Objective Studies have published the association between the expression of matrix metalloproteinases (MMPs) and the outcome of cervical cancer. However, the prognostic value in cervical cancer remains controversial. This meta-analysis was conducted to evaluate the prognostic functions of MMP expression in cervical cancer. Methods A comprehensive search of PubMed, Embase, and Web of Science databases was conducted to identify the eligible studies according to defined selection and excluding criteria and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Fixed and random effects models were evaluated through the hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate the overall survival (OS), recurrence-free survival (RFS), and progress-free survival (PFS). Results A total of 18 eligible studies including 1967 patients were analyzed for prognostic value. Totally 16 selected studies including 21 tests were relevant to the cervical cancer OS, 4 studies focused on RFS, and 1 study on PFS. The combined pooled HRs and 95% CIs of OS were calculated with random-effects models (HR = 1.64, 95% CI = 1.01–2.65, P = .000). In the subgroup analysis for OS, there was no heterogeneity in MMP-2 (I2 = .0%, P = .880), MMP-1 (I2 = .0%, P = .587), and MMP-14 (I2 = 28.3%, P = .248). In MMP-7 and MMP-9, the heterogeneities were obvious (I2 = 99.2% ( P = .000) and I2 = 77.9% ( P = .000), respectively). The pooled HRs and 95% CIs of RFS were calculated with fixed-effects models (HR = 2.22, 95% CI = 1.38–3.58, P = .001) and PFS (HR = 2.29, 95% CI = 1.14–4.58, P = .035). Conclusions The results indicated that MMP overexpression was associated with shorter OS and RFS in cervical cancer patients. It suggested that MMP overexpression might be a poor prognostic marker in cervical cancer. Research Registry Registration Number: reviewregistry 1159.

Triclosan-Coated Sutures Reduce the Risk of Surgical Site Infections: A Systematic Review and Meta-analysis

2015 ◽  
Vol 36 (2) ◽  
pp. 169-179 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Nalini Singh ◽  
Aila Nica Bandong ◽  
Gilbert Madriaga
Keyword(s):  
Systematic Review ◽  
Abdominal Surgery ◽  
Random Effects ◽  
Meta Analysis ◽  
Surgical Site Infections ◽  
Sensitivity Analyses ◽  
Publication Type ◽  
Random Effects Models ◽  
Meta Regression ◽  
Meta Analyses

OBJECTIVETo analyze available evidence on the effectiveness of triclosan-coated sutures (TCSs) in reducing the risk of surgical site infection (SSI).DESIGNSystematic review and meta-analysis.METHODSA systematic search of both randomized (RCTs) and nonrandomized (non-RCT) studies was performed on PubMed Medline, OVID, EMBASE, and SCOPUS, without restrictions in language and publication type. Random-effects models were utilized and pooled estimates were reported as the relative risk (RR) ratio with 95% confidence interval (CI). Tests for heterogeneity as well as meta-regression, subgroup, and sensitivity analyses were performed.RESULTSA total of 29 studies (22 RCTs, 7 non-RCTs) were included in the meta-analysis. The overall RR of acquiring an SSI was 0.65 (95% CI: 0.55–0.77; I2=42.4%, P=.01) in favor of TCS use. The pooled RR was particularly lower for the abdominal surgery group (RR: 0.56; 95% CI: 0.41–0.77) and was robust to sensitivity analysis. Meta-regression analysis revealed that study design, in part, may explain heterogeneity (P=.03). The pooled RR subgroup meta-analyses for randomized controlled trials (RCTs) and non-RCTs were 0.74 (95% CI: 0.61–0.89) and 0.53 (95% CI: 0.42–0.66), respectively, both of which favored the use of TCSs.CONCLUSIONThe random-effects meta-analysis based on RCTs suggests that TCSs reduced the risk of SSI by 26% among patients undergoing surgery. This effect was particularly evident among those who underwent abdominal surgery.Infect Control Hosp Epidemiol 2015;36(2): 1–11

scholarly journals Prediction intervals for random-effects meta-analysis: A confidence distribution approach

2018 ◽  
Vol 28 (6) ◽  
pp. 1689-1702 ◽  
Author(s):  
Kengo Nagashima ◽  
Hisashi Noma ◽  
Toshi A Furukawa
Keyword(s):  
Random Effects ◽  
Prediction Interval ◽  
Meta Analysis ◽  
Prediction Intervals ◽  
Point Estimate ◽  
Random Effects Models ◽  
Confidence Distribution ◽  
Large Sample Approximation ◽  
Sample Approximation ◽  
Meta Analyses

Prediction intervals are commonly used in meta-analysis with random-effects models. One widely used method, the Higgins–Thompson–Spiegelhalter prediction interval, replaces the heterogeneity parameter with its point estimate, but its validity strongly depends on a large sample approximation. This is a weakness in meta-analyses with few studies. We propose an alternative based on bootstrap and show by simulations that its coverage is close to the nominal level, unlike the Higgins–Thompson–Spiegelhalter method and its extensions. The proposed method was applied in three meta-analyses.

scholarly journals Stereotactic radiosurgery for non-functioning pituitary adenomas: meta-analysis and International Stereotactic Radiosurgery Society practice opinion

2019 ◽  
Vol 22 (3) ◽  
pp. 318-332 ◽  
Author(s):  
Rupesh Kotecha ◽  
Arjun Sahgal ◽  
Muni Rubens ◽  
Antonio De Salles ◽  
Laura Fariselli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiosurgery ◽  
Random Effects ◽  
Local Control ◽  
Pituitary Adenomas ◽  
Meta Analysis ◽  
Random Effects Models ◽  
Review Reports ◽  
Meta Analyses ◽  
Non Functioning Pituitary Adenomas

Abstract Background This systematic review reports on outcomes and toxicities following stereotactic radiosurgery (SRS) for non-functioning pituitary adenomas (NFAs) and presents consensus opinions regarding appropriate patient management. Methods Using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review was performed from articles of ≥10 patients with NFAs published prior to May 2018 from the Medline database using the key words “radiosurgery” and “pituitary” and/or “adenoma.” Weighted random effects models were used to calculate pooled outcome estimates. Results Of the 678 abstracts reviewed, 35 full-text articles were included describing the outcomes of 2671 patients treated between 1971 and 2017 with either single fraction SRS or hypofractionated stereotactic radiotherapy (HSRT). All studies were retrospective (level IV evidence). SRS was used in 27 studies (median dose: 15 Gy, range: 5–35 Gy) and HSRT in 8 studies (median total dose: 21 Gy, range: 12–25 Gy, delivered in 3–5 fractions). The 5-year random effects local control estimate after SRS was 94% (95% CI: 93.0–96.0%) and 97.0% (95% CI: 93.0–98.0%) after HSRT. The 10-year local control random effects estimate after SRS was 83.0% (95% CI: 77.0–88.0%). Post-SRS hypopituitarism was the most common treatment-related toxicity observed, with a random effects estimate of 21.0% (95% CI: 15.0–27.0%), whereas visual dysfunction or other cranial nerve injuries were uncommon (range: 0–7%). Conclusions SRS is an effective and safe treatment for patients with NFAs. Encouraging short-term data support HSRT for select patients, and mature outcomes are needed before definitive recommendations can be made. Clinical practice opinions were developed on behalf of the International Stereotactic Radiosurgery Society (ISRS).

scholarly journals Meta-Analysis of Sensorimotor Gating Deficits in Patients With Schizophrenia Evaluated by Prepulse Inhibition Test

2020 ◽  
Vol 46 (6) ◽  
pp. 1482-1497
Author(s):  
Rodrigo San-Martin ◽  
Leonardo Andrade Castro ◽  
Paulo Rossi Menezes ◽  
Francisco José Fraga ◽  
Priscyla Waleska Simões ◽  
...  
Keyword(s):  
Prepulse Inhibition ◽  
Random Effects ◽  
Effect Size ◽  
Meta Analysis ◽  
Sensorimotor Gating ◽  
Control Group ◽  
Random Effects Models ◽  
Meta Regression Analysis ◽  
High Level ◽  
Meta Analyses

Abstracts Prepulse inhibition (PPI) of startle is an operational measure of sensorimotor gating that is often impaired in patients with schizophrenia. Despite the large number of studies, there is considerable variation in PPI outcomes reported. We conducted a systematic review and meta-analysis investigating PPI impairment in patients with schizophrenia compared with healthy control subjects, and examined possible explanations for the variation in results between studies. Major databases were screened for observational studies comparing healthy subjects and patients with schizophrenia for the prepulse and pulse intervals of 60 and 120 ms as primary outcomes, ie, PPI-60 and PPI-120. Standardized mean difference (SMD) and 95% confidence intervals (CI) were extracted and pooled using random effects models. We then estimated the mean effect size of these measures with random effects meta-analyses and evaluated potential PPI heterogeneity moderators, using sensitivity analysis and meta-regressions. Sixty-seven primary studies were identified, with 3685 healthy and 4290 patients with schizophrenia. The schizophrenia group showed reduction in sensorimotor gating for both PPI-60 (SMD = −0.50, 95% CI = [−0.61, −0.39]) and PPI-120 (SMD = −0.44, 95% CI = [−0.54, −0.33]). The sensitivity and meta-regression analysis showed that sample size, gender proportion, imbalance for gender, source of control group, and study continent were sources of heterogeneity (P < .05) for both PPI-60 and PPI-120 outcomes. Our findings confirm a global sensorimotor gating deficit in schizophrenia patients, with overall moderate effect size for PPI-60 and PPI-120. Methodological consistency should decrease the high level of heterogeneity of PPI results between studies.

A Systematic Review and Meta-Analysis of the Utility of the Test of Memory Malingering in Pediatric Examinees

2020 ◽  
Vol 35 (8) ◽  
pp. 1312-1322
Author(s):  
Hilary A Clark ◽  
Phillip K Martin ◽  
Hayrettin Okut ◽  
Ryan W Schroeder
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Healthy Children ◽  
Performance Validity ◽  
Test Of Memory Malingering ◽  
Eligibility Criteria ◽  
Random Effects Models ◽  
Neuropsychological Evaluations ◽  
Meta Analyses ◽  
The Impact

Abstract Objective This is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) in pediatric examinees. It adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Method A systematic literature search was conducted using PsycINFO and PubMed, reviewing articles from January 1997 to July 2019. Books providing data on pediatric validity testing were also reviewed for references to relevant articles. Eligibility criteria included publication in a peer-reviewed journal, utilizing a pediatric sample, providing sufficient data to calculate specificity and/or sensitivity, and providing a means for evaluating validity status external to the TOMM. After selection criteria were applied, 9 articles remained for meta-analysis. Samples included clinical patients and healthy children recruited for research purposes; ages ranged from 5 to 18. Fixed and random effects models were used to calculate classification accuracy statistics. Results Traditional adult-derived cutoffs for Trial 2 and Retention were highly specific (0.96–0.99) in pediatric examinees for both clinical and research samples. Sensitivity was relatively strong (0.68–0.70), although only two studies reported sensitivity rates. A supplemental review of the literature corroborated these findings, revealing that traditional adult-based TOMM cutoffs are supported in most pediatric settings. However, limited research exists on the impact of very young age, extremely low cognitive functioning, and varying clinical diagnoses. Conclusions The TOMM, at traditional adult cutoffs, has strong specificity as a performance validity test in pediatric neuropsychological evaluations. This meta-analysis found that specificity values in children are comparable to those of adults. Areas for further research are discussed.

Evaluation of root resorption following orthodontic intrusion: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Silvio Augusto Bellini-Pereira ◽  
Jéssica Almeida ◽  
Aron Aliaga-Del Castillo ◽  
Cibelle Cristina Oliveira dos Santos ◽  
José Fernando Castanha Henriques ◽  
...  
Keyword(s):  
Random Effects ◽  
Randomized Clinical Trials ◽  
Root Resorption ◽  
Meta Analysis ◽  
Grey Literature ◽  
Eligibility Criteria ◽  
Related Factors ◽  
Assessment Development ◽  
Grade Of Recommendation ◽  
Meta Analyses

Summary Background/Objective To quantify the expected amount of orthodontically induced root resorption (OIRR) after orthodontic intrusion and assess the treatment-related factors. Search methods and eligibility criteria Six electronic databases and partial grey literature were searched without limitations regarding language or publication year until April 2020. Randomized clinical trials and non-randomized prospective and retrospective studies evaluating root resorption after orthodontic intrusion were included. Data collection and analysis Risk of bias (RoB) assessment was performed with the Cochrane Collaboration’s RoB Tool 2.0 and ROBINS-I tool for the randomized and non-randomized studies, respectively. The data were combined into two random-effects meta-analyses estimating OIRR following orthodontic intrusion. One evaluated OIRR in the anterior region, while the other assessed OIRR in the posterior region. Sub-group analyses regarding the type of mechanics applied, duration of intrusion, amount of force, and sensitivity analysis of the study design and imaging examinations were also performed. The certainty of the evidence was assessed through the Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Results The qualitative analysis included 14 studies; however, the meta-analysis was performed with 7 records. The random-effects model assumes that 0.72 mm [95% confidence interval (CI): 0.16 to 1.28] and 0.41 mm (95% CI: −0.24 to 1.07) of OIRR should be expected in the incisors and the molars, respectively. Sub-group analyses showed that the assessed treatment-related factors presented minimum impact in OIRR after orthodontic intrusion. The GRADE resulted in moderate and low certainty regarding the meta-analysis. Limitations The major limitation of the present meta-analysis is that OIRR can be affected by several factors, some of which are assessed in this review. Conclusions Orthodontic intrusion, evaluated as an isolated mechanic, caused less than 1 mm of OIRR, which is within the acceptable limits for clinical implication. Treatment-related factors did not show a significant influence on OIRR. Registration This review was registered in PROSPERO, protocol number CRD42018098495.

Random-effects meta-analysis: the number of studies matters

2015 ◽  
Vol 26 (3) ◽  
pp. 1500-1518 ◽  
Author(s):  
Annamaria Guolo ◽  
Cristiano Varin
Keyword(s):  
Random Effects ◽  
Type I Error ◽  
Meta Analysis ◽  
Practical Interest ◽  
Error Rates ◽  
Type I ◽  
Model Framework ◽  
Random Effects Models ◽  
Meta Analyses ◽  
The Impact

This paper investigates the impact of the number of studies on meta-analysis and meta-regression within the random-effects model framework. It is frequently neglected that inference in random-effects models requires a substantial number of studies included in meta-analysis to guarantee reliable conclusions. Several authors warn about the risk of inaccurate results of the traditional DerSimonian and Laird approach especially in the common case of meta-analysis involving a limited number of studies. This paper presents a selection of likelihood and non-likelihood methods for inference in meta-analysis proposed to overcome the limitations of the DerSimonian and Laird procedure, with a focus on the effect of the number of studies. The applicability and the performance of the methods are investigated in terms of Type I error rates and empirical power to detect effects, according to scenarios of practical interest. Simulation studies and applications to real meta-analyses highlight that it is not possible to identify an approach uniformly superior to alternatives. The overall recommendation is to avoid the DerSimonian and Laird method when the number of meta-analysis studies is modest and prefer a more comprehensive procedure that compares alternative inferential approaches. R code for meta-analysis according to all of the inferential methods examined in the paper is provided.

scholarly journals P.023 Neurostimulation in Drug-Resistant Epilepsy: Systematic Review and Meta-Analysis from the ILAE Evidence-Based Epilepsy Surgery Task Force

2021 ◽  
Vol 48 (s3) ◽  
pp. S26-S26
Author(s):  
L Touma ◽  
B Dansereau ◽  
D Englot ◽  
MR Keezer
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Meta Analysis ◽  
Case Series ◽  
Current Evidence ◽  
Drug Resistant ◽  
Seizure Reduction ◽  
Drug Resistant Epilepsy

Background: Drug-resistant epilepsy (DRE) can affect up to one third of individuals with epilepsy. We conducted a systematic review and meta-analysis of vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) in patients with DRE to summarize the current evidence on efficacy and tolerability for these neuromodulation modalities. Methods: We searched three online databases with a pre-specified search strategy. We included published randomized controlled trials (RCT) and their open-label extension studies, as well as prospective case series, with samples greater than 20 participants, reporting efficacy and tolerability. Results: We identified 31 studies, six of which are RCTs and 25 prospective observational studies. At long term follow-up, five observational studies for VNS reported a pooled mean decrease in seizure frequency at last follow-up of 35%. In the extension studies for RNS, the median seizure reduction was 53%, 66% and 75.0% at two, five and nine years respectively. For DBS, the median reduction was then 56%, 69% and 75% at two, five and seven years respectively. Conclusions: Neurostimulation modalities are effective for the treatment of DRE, with improving outcomes over time and few major complications. Higher quality long-term data on DBS and RNS suggest larger seizure reduction rates than VNS.

Moment and Least-Squares Based Approaches to Meta-analytic Inference

2013 ◽  
Author(s):  
Michael S. Rosenberg
Keyword(s):  
Least Squares ◽  
Random Effects ◽  
Meta Analysis ◽  
Structural Models ◽  
Sums Of Squares ◽  
Random Effects Models ◽  
Weighted Means ◽  
The Moment ◽  
The One ◽  
Meta Analyses

Chapter 8 introduced variance and structural models and various statistical inference approaches used in meta-analysis. This chapter describes the basic details behind the moment and least-squares approach to meta-analysis. This approach represents “classic” meta-analysis; it is the one most frequently found in meta-analytic introductions and used in ecological meta-analyses to date. This approach to meta-analytic inference has the advantage of using fairly simple formulas (for basic structural models) that can be easily calculated, and it is clearly and directly comparable to common statistical concepts, such as weighted means and sums of squares. The disadvantages of this approach is that it is less amenable to more complex modeling, particularly when considering features such as interaction effects; it also has certain limitations that in some cases reduce the applicability of random-effects models.

Sign in / Sign up

Export Citation Format

Share Document