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Cirugía para la epilepsia
Siobhan West, Sarah J Nevitt, Jennifer Cotton, Sacha Gandhi, Jennifer Weston, Ajay Sudan, Roberto Ramirez, Richard Newton | 25 junio 2019

Topics

Temas

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Comparison 1 IVIg versus placebo, Outcome 1 50% or greater reduction in seizure frequency for refractory epilepsy, ITT analysis.
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Analysis 1.1

Comparison 1 IVIg versus placebo, Outcome 1 50% or greater reduction in seizure frequency for refractory epilepsy, ITT analysis.

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Comparison 1 IVIg versus placebo, Outcome 2 50% or greater reduction in seizure frequency for refractory epilepsy, per‐protocol.
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Analysis 1.2

Comparison 1 IVIg versus placebo, Outcome 2 50% or greater reduction in seizure frequency for refractory epilepsy, per‐protocol.

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Comparison 1 IVIg versus placebo, Outcome 3 50% or greater reduction in seizure frequency for refractory epilepsy, best‐case.
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Analysis 1.3

Comparison 1 IVIg versus placebo, Outcome 3 50% or greater reduction in seizure frequency for refractory epilepsy, best‐case.

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Comparison 1 IVIg versus placebo, Outcome 4 50% or greater reduction in seizure frequency for refractory partial epilepsy, ITT analysis.
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Analysis 1.4

Comparison 1 IVIg versus placebo, Outcome 4 50% or greater reduction in seizure frequency for refractory partial epilepsy, ITT analysis.

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Comparison 1 IVIg versus placebo, Outcome 5 50% or greater reduction in seizure frequency for refractory partial epilepsy, per‐protocol.
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Analysis 1.5

Comparison 1 IVIg versus placebo, Outcome 5 50% or greater reduction in seizure frequency for refractory partial epilepsy, per‐protocol.

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Comparison 1 IVIg versus placebo, Outcome 6 50% or greater reduction in seizure frequency for refractory partial epilepsy, best‐case.
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Analysis 1.6

Comparison 1 IVIg versus placebo, Outcome 6 50% or greater reduction in seizure frequency for refractory partial epilepsy, best‐case.

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Comparison 1 IVIg versus placebo, Outcome 7 Global assessment for refractory epilepsy, ITT analysis.
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Analysis 1.7

Comparison 1 IVIg versus placebo, Outcome 7 Global assessment for refractory epilepsy, ITT analysis.

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Comparison 1 IVIg versus placebo, Outcome 8 Global assessment for refractory epilepsy, per‐protocol.
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Analysis 1.8

Comparison 1 IVIg versus placebo, Outcome 8 Global assessment for refractory epilepsy, per‐protocol.

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Comparison 1 IVIg versus placebo, Outcome 9 Global assessment for refractory epilepsy, best‐case.
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Analysis 1.9

Comparison 1 IVIg versus placebo, Outcome 9 Global assessment for refractory epilepsy, best‐case.

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Summary of findings for the main comparison. IVIg compared to placebo for refractory epilepsy

IVIg compared to placebo for refractory epilepsy

Patient or population: patients with refractory epilepsy
Settings: three participating hospitals‐Ottignies (Belgium), Zurich (Switzerland) and Kehl‐Kork (Germany)
Intervention: IVIg
Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo

IVIg

Seizure freedom

Not reported

Satisfactory seizure control
50% or greater reduction in seizure frequency for refractory epilepsy

278 per 1000

525 per 1000
(236 to 1000)

RR 1.89
(0.85 to 4.21)

58
(1 study)

⊕⊕⊝⊝
low1,2

Incidence of adverse or harmful effects

Not reported

Global assessment

167 per 1000

548 per 1000
(188 to 1000)

RR 3.29
(1.13 to 9.57)

60
(1 study)

⊕⊕⊝⊝
low1,2

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Unclear risk of selection bias: no information was obtained on generation of the random sequence or concealment of allocation of the randomisation.
2 More trials and patients are needed to allow more precise estimation of the treatment effects of IVIg.

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Summary of findings for the main comparison. IVIg compared to placebo for refractory epilepsy
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Comparison 1. IVIg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 50% or greater reduction in seizure frequency for refractory epilepsy, ITT analysis Show forest plot

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

1.76 [0.79, 3.93]

2 50% or greater reduction in seizure frequency for refractory epilepsy, per‐protocol Show forest plot

1

58

Risk Ratio (M‐H, Fixed, 95% CI)

1.89 [0.85, 4.21]

3 50% or greater reduction in seizure frequency for refractory epilepsy, best‐case Show forest plot

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

2.01 [0.91, 4.43]

4 50% or greater reduction in seizure frequency for refractory partial epilepsy, ITT analysis Show forest plot

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

3.08 [0.84, 11.34]

5 50% or greater reduction in seizure frequency for refractory partial epilepsy, per‐protocol Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

3.35 [0.91, 12.30]

6 50% or greater reduction in seizure frequency for refractory partial epilepsy, best‐case Show forest plot

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

3.57 [0.98, 13.00]

7 Global assessment for refractory epilepsy, ITT analysis Show forest plot

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

3.21 [1.10, 9.36]

8 Global assessment for refractory epilepsy, per‐protocol Show forest plot

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

3.29 [1.13, 9.57]

9 Global assessment for refractory epilepsy, best‐case Show forest plot

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

3.35 [1.15, 9.73]
Figuras y tablas -
Comparison 1. IVIg versus placebo
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