{
  "abstract": "Background Despite advances in epilepsy surgery, seizure freedom is achieved in only ~50–70% of cases, highlighting the need to better understand factors driving surgical success.Methods A preregistered systematic review and individual patient data meta-analysis was conducted on studies reporting clinical outcomes in epilepsy surgery, based on a comprehensive literature search through August 2024. Data were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Unique patient data from 385 studies were pooled, yielding 5588 patients with outcomes, localisation, demographics, pathology and other findings. Surgical success rates (% Engel 1/ILAE 1–2) were reported with 95% Wald CIs. Associations with patient- and disease-specific factors were assessed using chi-squared tests (p<0.05), effect sizes with Cramer’s V, and post hoc comparisons adjusted using the false discovery rate.Results Surgical success varied by lobar anatomy (χ²=52, p<0.001, V=0.12), with the highest success rates in temporal (68.6% (67.0% to 70.1%)) and insular lobes (66.2% (55.4% to 77.0%)). Multilobar resections had lower success rates, with outcomes varying by lobar combination (χ²=25, p=0.02, V=0.22). Variability in outcomes was influenced by histopathology and MRI findings (χ²=121, p<0.001, V=0.16; highest success in tumours (78.2% (74.9% to 81.6%))) and by surgical intervention (χ²=30.5, p<0.001, V=0.07; lowest success with corpus callosotomy (43.4% (35.4% to 51.5%))). Overall surgical success rates remained stable over time (r=0.25, p=0.13), despite surgery being extended to more complex patients.Conclusions These findings inform surgical planning for drug-resistant epilepsy, emphasising individual patient characteristics to guide personalised treatment, improve outcomes and reflect the growing complexity of intersecting factors.PROSPERO registration number CRD42024530397.",
  "authors": [
    {
      "affiliations": [
        "Analytical Neurophysiology Lab, McGill University, Montréal, Québec, Canada",
        "Analytical Neurophysiology Lab, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA"
      ],
      "name": "Tamir Avigdor"
    },
    {
      "affiliations": [
        "Analytical Neurophysiology Lab, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA"
      ],
      "name": "Alyssa Ho"
    },
    {
      "affiliations": [
        "Analytical Neurophysiology Lab, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA"
      ],
      "name": "Matthew Moye"
    },
    {
      "affiliations": [
        "McGill University Faculty of Medicine, Montreal, Quebec, Canada"
      ],
      "name": "William Davalan"
    },
    {
      "affiliations": [
        "Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada"
      ],
      "name": "Erica Minato"
    },
    {
      "affiliations": [
        "Department of Biomedical and Life Sciences, Lancaster University, Lancaster, UK"
      ],
      "name": "Sana Hannan"
    },
    {
      "affiliations": [
        "Department of Biomedical and Life Sciences, Lancaster University, Lancaster, UK"
      ],
      "name": "Tamzin Holden"
    },
    {
      "affiliations": [
        "McGill University Faculty of Medicine, Montreal, Quebec, Canada"
      ],
      "name": "Tasha Bouchet"
    },
    {
      "affiliations": [
        "Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada"
      ],
      "name": "Yingqi Laetitia Wang"
    },
    {
      "affiliations": [
        "Analytical Neurophysiology Lab, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA",
        "Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA"
      ],
      "name": "Kassem Jaber"
    },
    {
      "affiliations": [
        "Analytical Neurophysiology Lab, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA"
      ],
      "name": "Mays Khweileh"
    },
    {
      "affiliations": [
        "Duke University Medical Center Library, Duke University School of Medicine, Durham, North Carolina, USA"
      ],
      "name": "Samantha Kaplan"
    },
    {
      "affiliations": [
        "Czech Academy of Sciences, Brno, Czech Republic",
        "International Clinical Research Centre, St Anne’s University Hospital Brno, Brno, Czech Republic"
      ],
      "name": "Vojtech Travnicek"
    },
    {
      "affiliations": [
        "Duke University Institute of Statistics and Decision Sciences, Durham, North Carolina, USA",
        "Department of Computer Science, Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina, USA"
      ],
      "name": "David Carlson"
    },
    {
      "affiliations": [
        "Analytical Neurophysiology Lab, McGill University, Montréal, Québec, Canada",
        "Analytical Neurophysiology Lab, Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA",
        "Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA"
      ],
      "name": "Birgit Frauscher"
    }
  ],
  "title": "Epilepsy surgery outcomes and their determinants: a systematic review and individual patient data meta-analysis",
  "uid": "3963a0d8-b123-5a98-9d39-5a1a540e4363"
}